Healthcare Provider Details

I. General information

NPI: 1457648719
Provider Name (Legal Business Name): APPLIED PSYCHOLOGY GROUP OF TEXOMA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 REPUBLIC DR STE 325
PLANO TX
75074-8867
US

IV. Provider business mailing address

555 REPUBLIC DR STE 325
PLANO TX
75074-8867
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-0298
  • Fax: 903-892-6323
Mailing address:
  • Phone: 903-893-0298
  • Fax: 903-892-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: NEHA PATEL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 903-893-0298