Healthcare Provider Details

I. General information

NPI: 1932162898
Provider Name (Legal Business Name): GARY B. ROCHELLE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 OHIO DR STE. 130
PLANO TX
75093-3927
US

IV. Provider business mailing address

2220 COIT RD STE. 480, PMB 304
PLANO TX
75075-3797
US

V. Phone/Fax

Practice location:
  • Phone: 214-498-9392
  • Fax: 972-596-0238
Mailing address:
  • Phone: 214-498-9392
  • Fax: 972-596-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number15435
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: