Healthcare Provider Details

I. General information

NPI: 1184314890
Provider Name (Legal Business Name): CEREBRAL COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4888 DEXTER DRIVE SUITE 300B
PLANO TX
75093
US

IV. Provider business mailing address

4888 DEXTER DRIVE SUITE 300B
PLANO TX
75093
US

V. Phone/Fax

Practice location:
  • Phone: 512-785-3301
  • Fax: 866-585-0224
Mailing address:
  • Phone: 512-785-3301
  • Fax: 866-585-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBYN MICHELE RICHARDSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 512-785-3301