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General NPI Number Information
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NPI Number | 1952062754
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Entity Type | Organization
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Legal Business Name | CHILD PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 107 LARSON LN STE 200
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City | ALEDO
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State | TX
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Zip | 76008-4593
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Country | US
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Telephone | 817-668-5056
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Fax | 817-476-4090
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Provider Business Mailing Address
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Address Line | 12832 MODENA CT
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City | FORT WORTH
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State | TX
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Zip | 76126-6117
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Country | US
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Telephone | 425-238-2873
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Fax | 425-309-5187
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | JANET O'DONNELL
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Credential | PSYD
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Telephone | 425-238-2873
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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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