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General NPI Number Information
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NPI Number | 1174109276
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Entity Type | Individual
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Provider Name | MICHELLE GAYLE LA SPATA PHD
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Gender | Female
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Dates
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Enumeration Date | 03/20/2021
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 5575 WARREN PKWY STE 120
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City | FRISCO
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State | TX
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Zip | 75034-4093
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Country | US
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Telephone | 844-824-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 LAKE CREST LN
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City | LEWISVILLE
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State | TX
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Zip | 75057-2615
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Country | US
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Telephone | 630-712-0019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 38624
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 71870
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 38624
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License Number State | TX
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