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General NPI Number Information
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NPI Number | 1972736916
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Entity Type | Organization
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Legal Business Name | J&P PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 900 HEDGCOXE RD
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City | PLANO
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State | TX
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Zip | 75025-2554
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Country | US
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Telephone | 972-765-2643
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Fax |
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Provider Business Mailing Address
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Address Line | 7801 ALMA DR SUITE 301
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City | PLANO
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State | TX
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Zip | 75025-3482
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Country | US
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Telephone | 972-765-2643
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN MANUEL PITA
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Credential | PH.D.
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Telephone | 972-765-2643
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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 | 24790
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License Number State | TX
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