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General NPI Number Information
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NPI Number | 1619592722
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Entity Type | Organization
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Legal Business Name | WEST PLANO PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 5055 W PARK BLVD STE 400
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City | PLANO
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State | TX
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Zip | 75093-2590
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Country | US
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Telephone | 972-824-6577
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Fax |
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Provider Business Mailing Address
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Address Line | 5055 W PARK BLVD STE 400
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City | PLANO
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State | TX
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Zip | 75093-2590
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Country | US
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Telephone | 972-824-6577
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Fax |
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Authorized Official
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Title or Position | LPC, LMFT
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Name | MARY A RADTKE
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Credential | MED
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Telephone | 972-824-6177
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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