MEDICARE: EVAN BODINE PH.D.

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	103T00000X	Psychologist	37871	TX

General Provider Information

NPI Number	:	1154896850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN BODINE PH.D.

Provider Business Mailing Address
First Line	:	8140 WALNUT HILL LN STE 440
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4328
Country	:	US
Telephone Number	:	972-913-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	8140 WALNUT HILL LN STE 440
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4328
Country	:	US
Telephone Number	:	972-913-6879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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Directions to “ EVAN BODINE PH.D.” Practice Location

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