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General NPI Number Information
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NPI Number | 1922505551
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Entity Type | Organization
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Legal Business Name | GLEN FOREST PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 3006 BEE CAVES RD STE A212
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City | AUSTIN
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State | TX
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Zip | 78746-5767
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Country | US
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Telephone | 512-767-1136
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Fax |
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Provider Business Mailing Address
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Address Line | 3006 BEE CAVES RD STE A212
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City | AUSTIN
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State | TX
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Zip | 78746-5767
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Country | US
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Telephone | 512-767-1136
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. TYSON DAVIS
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Credential | PSYD
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Telephone | 512-767-1136
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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 | PS017720
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License Number State | PA
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