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General NPI Number Information
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NPI Number | 1942437272
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Entity Type | Organization
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Legal Business Name | ANDREA T VANDERPOOL, PH.D., PLLC
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 2255 RIDGE RD SUITE 210
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City | ROCKWALL
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State | TX
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Zip | 75087-5155
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Country | US
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Telephone | 972-722-1711
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Fax | 972-722-1711
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Provider Business Mailing Address
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Address Line | 2255 RIDGE RD SUITE 210
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City | ROCKWALL
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State | TX
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Zip | 75087-5155
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Country | US
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Telephone | 972-722-1711
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Fax | 972-722-1711
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ANDREA T VANDERPOOL
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Credential | PH.D.
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Telephone | 972-722-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 33850
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License Number State | TX
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