Healthcare Provider Details

I. General information

NPI: 1952809147
Provider Name (Legal Business Name): NEURODEVELOPMENT ASSOCIATES OF NORTH TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 LEGACY DR STE 200
PLANO TX
75024-2189
US

IV. Provider business mailing address

4508 LEGACY DR STE 200
PLANO TX
75024-2189
US

V. Phone/Fax

Practice location:
  • Phone: 469-408-0331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65709
License Number StateTX

VIII. Authorized Official

Name: KATHERINE KOEHLER
Title or Position: DOCTOR/OWNER
Credential:
Phone: 469-408-0331