Healthcare Provider Details

I. General information

NPI: 1992164115
Provider Name (Legal Business Name): OCD AND ANXIETY SPECIALISTS OF DALLAS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MUNICIPAL DR SUITE 230
RICHARDSON TX
75080
US

IV. Provider business mailing address

375 MUNICIPAL DR STE 230
RICHARDSON TX
75080-3624
US

V. Phone/Fax

Practice location:
  • Phone: 214-368-6999
  • Fax: 972-643-9394
Mailing address:
  • Phone: 214-368-6999
  • Fax: 972-643-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLPC 8758
License Number StateTX

VIII. Authorized Official

Name: DR. KIMBERLY EVONNE ROCKWELL-EVANS
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: PH.D.
Phone: 214-368-6999