Healthcare Provider Details

I. General information

NPI: 1801001110
Provider Name (Legal Business Name): LAURIE MICHELLE RILLING PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
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
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY006567
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: