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General NPI Number Information
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NPI Number | 1619707338
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Entity Type | Organization
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Legal Business Name | THE PLACE PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 1901 CLIFTON DR
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City | MESQUITE
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State | TX
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Zip | 75149-5491
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Country | US
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Telephone | 469-701-0983
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Fax |
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Provider Business Mailing Address
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Address Line | 5473 BLAIR RD STE 100 PMB 767367
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City | DALLAS
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State | TX
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Zip | 75231-4427
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Country | US
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Telephone | 469-701-0983
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER RENEE MILLER
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Credential | LCSW
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Telephone | 490-701-0983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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