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General NPI Number Information
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NPI Number | 1154812048
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Entity Type | Organization
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Legal Business Name | DENTON INTEGRATIVE PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 2220 SAN JACINTO BLVD SUITE 355
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City | DENTON
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State | TX
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Zip | 76205-7591
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Country | US
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Telephone | 940-565-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 SAN JACINTO BLVD STE 355
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City | DENTON
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State | TX
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Zip | 76205-7591
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Country | US
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Telephone | 940-565-0155
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. CAROLA HUNDRICH-SOURIS
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Credential | PH.D.
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Telephone | 940-565-0155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2-6863
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License Number State | TX
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