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General NPI Number Information
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NPI Number | 1942771787
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Entity Type | Organization
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Legal Business Name | PREMIER PSYCHOLOGY CONSULTANTS PLLC
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 1725 E SOUTHLAKE BLVD STE 102
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6457
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Country | US
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Telephone | 682-477-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 E SOUTHLAKE BLVD SUITE 102
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City | SOUTHLAKE
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State | TX
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Zip | 76092
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Country | US
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Telephone | 682-477-4400
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Fax |
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Authorized Official
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Title or Position | PH.D. / PSYCHOLOGIST
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Name | DR. MARIETTA RICHARD
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Credential | PH.D.
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Telephone | 682-477-4400
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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 |
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License Number State |
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