=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053686360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHWORTH PSYCHOLOGICAL SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2012
-----------------------------------------------------
Last Update Date | 03/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8344 E R L THORNTON FWY SUITE 410-B
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75228-7136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-390-3411
-----------------------------------------------------
Fax | 214-666-4208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3330 N. GALLOWAY AVE. SUITE 304, BOX 17
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-390-3411
-----------------------------------------------------
Fax | 214-666-4208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOLOGIST
-----------------------------------------------------
Name | JANET K ASHWORTH
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 214-390-3411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 15755
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------