Healthcare Provider Details

I. General information

NPI: 1588846711
Provider Name (Legal Business Name): CENTER FOR NEUROBEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 GRANITE PKWY SUITE 200
PLANO TX
75024-6622
US

IV. Provider business mailing address

5700 GRANITE PKWY SUITE 200
PLANO TX
75024-6622
US

V. Phone/Fax

Practice location:
  • Phone: 972-731-6985
  • Fax: 972-731-6986
Mailing address:
  • Phone: 972-731-6985
  • Fax: 972-731-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number33537
License Number StateTX

VIII. Authorized Official

Name: DR. LAURIE M RILLING
Title or Position: DIRECTOR/CLINICAL NEUROPSYCHOLOGIST
Credential: PHD
Phone: 972-731-6985