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General NPI Number Information
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NPI Number | 1356753362
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Entity Type | Organization
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Legal Business Name | IRIS PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 05/25/2014
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Last Update Date | 05/25/2014
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Provider Practice Location Address
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Address Line | 1201 N WATSON RD SUITE 117
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City | ARLINGTON
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State | TX
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Zip | 76006-6190
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Country | US
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Telephone | 817-962-0035
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 50564
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City | FORT WORTH
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State | TX
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Zip | 76006-6190
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Country | US
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Telephone | 817-962-0035
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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. LISA D HENSLEY
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Credential | PH.D.
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Telephone | 817-962-0035
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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 | 36730
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License Number State | TX
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