=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063028108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTUITIVE PATHWAY PSYCHOLOGICAL SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2020
-----------------------------------------------------
Last Update Date | 09/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 W HICKORY ST STE 304
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201-4151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-560-4091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 W HICKORY ST STE 304
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201-4151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-560-4091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ENNY TORRES YANEZ
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 972-560-4091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------