MEDICARE: DR. LOUISA JOLANDA SCAMPERLE PSYD

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	39358	TX

General Provider Information

NPI Number	:	1518702364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUISA JOLANDA SCAMPERLE PSYD

Provider Business Mailing Address
First Line	:	3530 TRAVIS ST APT 205
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1462
Country	:	US
Telephone Number	:	480-694-8249
Fax Number	:

Provider Business Practice Location Address
First Line	:	16970 DALLAS PKWY STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1928
Country	:	US
Telephone Number	:	214-556-3739
Fax Number	:

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

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	06/25/2024

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