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General NPI Number Information
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NPI Number | 1093530230
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR EDUCATIONAL DIAGNOSTICS & ASSESSMENT
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 262 CARROLL ST STE 150
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City | FORT WORTH
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State | TX
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Zip | 76107-1907
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Country | US
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Telephone | 979-218-1068
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Fax |
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Provider Business Mailing Address
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Address Line | 4628 LAFAYETTE AVE
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City | FORT WORTH
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State | TX
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Zip | 76107-3722
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Country | US
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Telephone | 979-218-1068
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KARLA EIDSON
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Credential |
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Telephone | 979-218-1068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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