Healthcare Provider Details

I. General information

NPI: 1568223717
Provider Name (Legal Business Name): PROCTOR PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 CALADIUM AVE
RICHARDSON TX
75080-8427
US

IV. Provider business mailing address

433 BELLE GROVE DR # 830369
RICHARDSON TX
75080-5200
US

V. Phone/Fax

Practice location:
  • Phone: 405-586-4522
  • Fax:
Mailing address:
  • Phone: 405-586-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA PROCTOR
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD
Phone: 405-586-4522