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General NPI Number Information
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NPI Number | 1568923365
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Entity Type | Organization
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Legal Business Name | DALLAS THERAPY ALLIANCE
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 12801 N CENTRAL EXPY STE 1730
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City | DALLAS
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State | TX
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Zip | 75243-1872
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Country | US
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Telephone | 214-736-4352
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Fax |
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Provider Business Mailing Address
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Address Line | 12801 N CENTRAL EXPY STE 1730
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City | DALLAS
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State | TX
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Zip | 75243-1872
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Country | US
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Telephone | 214-736-4352
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | RICHARD ANTHONY ENANDER
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Credential | PHD
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Telephone | 214-736-4352
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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