Healthcare Provider Details

I. General information

NPI: 1336806223
Provider Name (Legal Business Name): PERCEPTIVE PSYCHOLOGICAL PRACTICE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 11/26/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 S COIT
PROSPER TX
75078
US

IV. Provider business mailing address

2633 MCKINNEY AVE STE 130 #395
DALLAS TX
75204
US

V. Phone/Fax

Practice location:
  • Phone: 202-713-9196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CHARLA LEWIS
Title or Position: OWNER
Credential:
Phone: 202-713-9196