MEDICARE: PSYCHOLOGY SERVICES OF NORTH TEXAS

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	103TC0700X	Clinical Psychologist	32477	TX

General Provider Information

NPI Number	:	1033318860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGY SERVICES OF NORTH TEXAS

Provider Business Mailing Address
First Line	:	1100 AIRPORT FWY
Second Line	:	SUITE 202
City	:	BEDFORD
State	:	TX
Zip	:	76022-6667
Country	:	US
Telephone Number	:	817-354-5554
Fax Number	:	817-354-5556

Provider Business Practice Location Address
First Line	:	1100 AIRPORT FWY
Second Line	:	SUITE 202
City	:	BEDFORD
State	:	TX
Zip	:	76022-6667
Country	:	US
Telephone Number	:	817-354-5554
Fax Number	:	817-354-5556

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. LESLIE M. FARIS
Credential	:	PHD
Telephone Number	:	817-354-5554

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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