MEDICARE: NORTH DALLAS PSYCHOLOGICAL PRACTICE

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

General Provider Information

NPI Number	:	1538256771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH DALLAS PSYCHOLOGICAL PRACTICE

Provider Business Mailing Address
First Line	:	6330 LBJ FWY STE 236
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6431
Country	:	US
Telephone Number	:	972-231-1211
Fax Number	:	972-231-1211

Provider Business Practice Location Address
First Line	:	6330 LBJ FWY STE 236
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6431
Country	:	US
Telephone Number	:	972-231-1211
Fax Number	:	972-231-1211

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. NEIL F. RAVELLA
Credential	:	PH.D.
Telephone Number	:	972-231-1211

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	09/12/2022

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