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General NPI Number Information
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NPI Number | 1154038578
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Entity Type | Organization
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Legal Business Name | ARDENT PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 180 STATE ST
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7620
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Country | US
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Telephone | 682-477-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 2736 STADIUM VIEW DR
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City | FORT WORTH
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State | TX
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Zip | 76118-2031
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Country | US
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Telephone | 513-316-3004
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. ROZEMARIJN STAAL
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Credential | PSYD
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Telephone | 682-477-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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