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General NPI Number Information
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NPI Number | 1134731813
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Entity Type | Organization
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Legal Business Name | ON-SITE PSYCHOLOGY SERVICES
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 08/23/2020
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Provider Practice Location Address
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Address Line | 751 HEBRON PKWY STE 240
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City | LEWISVILLE
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State | TX
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Zip | 75057-5122
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Country | US
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Telephone | 469-825-0414
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Fax | 888-835-2599
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Provider Business Mailing Address
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Address Line | 751 HEBRON PKWY STE 240
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City | LEWISVILLE
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State | TX
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Zip | 75057-5122
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Country | US
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Telephone | 469-825-0414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY C JOHNSON
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Credential | PSY.D
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Telephone | 469-825-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State | NULL
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Taxonomy #3
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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 | NULL
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Taxonomy #4
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NULL
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