=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992033609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUNT LIZARD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2009
-----------------------------------------------------
Last Update Date | 11/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1406 N CORINTH ST SUITE 410
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76208-5448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-315-1798
-----------------------------------------------------
Fax | 972-315-0809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 986 CAMDEN DR.
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-7429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-315-1798
-----------------------------------------------------
Fax | 972-315-0809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KARIN ELIZABETH CURTISS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 972-315-1798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 31053
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------