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General NPI Number Information
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NPI Number | 1871782094
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Entity Type | Individual
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Provider Name | CAROLA HUNDRICH-SOURIS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 2220 SAN JACINTO BLVD SUITE 355
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City | DENTON
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State | TX
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Zip | 76205-7589
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Country | US
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Telephone | 940-565-0155
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Fax | 940-565-5005
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Provider Business Mailing Address
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Address Line | 2220 SAN JACINTO BLVD SUITE 355
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City | DENTON
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State | TX
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Zip | 76205-7589
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Country | US
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Telephone | 940-565-0155
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Fax | 940-565-5005
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2-6863
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License Number State | TX
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