MEDICARE: DOCTHERESE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0100X	Health Service Psychologist	23197	TX

General Provider Information

NPI Number	:	1023432481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTHERESE PLLC

Provider Business Mailing Address
First Line	:	6812 FAIR MEADOWS DR
Second Line	:
City	:	N RICHLND HLS
State	:	TX
Zip	:	76182-7611
Country	:	US
Telephone Number	:	817-228-6819
Fax Number	:	866-801-2988

Provider Business Practice Location Address
First Line	:	6812 FAIR MEADOWS DR
Second Line	:
City	:	N RICHLND HLS
State	:	TX
Zip	:	76182-7611
Country	:	US
Telephone Number	:	817-228-6819
Fax Number	:	866-801-2988

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. THERESE ADAMIEC
Credential	:	PH.D.
Telephone Number	:	817-228-6819

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	02/05/2014

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Directions to “DOCTHERESE PLLC ” Practice Location

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