Healthcare Provider Details

I. General information

NPI: 1497933147
Provider Name (Legal Business Name): PURVI PATEL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number36774
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number36774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: