MEDICARE: DR. MYCHELLE MARIE TORRES PSY.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	103TC0700X	Clinical Psychologist	35S100524800	NJ
2	103TC0700X	Clinical Psychologist	38116	TX

General Provider Information

NPI Number	:	1164584835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYCHELLE MARIE TORRES PSY.D.

Provider Business Mailing Address
First Line	:	4214 ROARING FORK LN
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-2839
Country	:	US
Telephone Number	:	469-777-3204
Fax Number	:

Provider Business Practice Location Address
First Line	:	7272 WURZBACH RD STE 706
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4803
Country	:	US
Telephone Number	:	210-615-3483
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	02/08/2024

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