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General NPI Number Information
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NPI Number | 1518481548
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Entity Type | Individual
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Provider Name | NEETHA DEVDAS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 1205 S WHITE CHAPEL BLVD STE 280
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9330
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Country | US
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Telephone | 682-651-8651
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Fax |
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Provider Business Mailing Address
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Address Line | 7202 ARCHES AVE
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City | IRVING
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State | TX
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Zip | 75063-3556
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Country | US
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Telephone | 469-371-3462
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 36107
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License Number State | TX
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