MEDICARE: DR. CAROLA HUNDRICH-SOURIS 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	103TC0700X	Clinical Psychologist	2-6863	TX

General Provider Information

NPI Number	:	1871782094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLA HUNDRICH-SOURIS PH.D.

Provider Business Mailing Address
First Line	:	2220 SAN JACINTO BLVD
Second Line	:	SUITE 355
City	:	DENTON
State	:	TX
Zip	:	76205-7589
Country	:	US
Telephone Number	:	940-565-0155
Fax Number	:	940-565-5005

Provider Business Practice Location Address
First Line	:	2220 SAN JACINTO BLVD
Second Line	:	SUITE 355
City	:	DENTON
State	:	TX
Zip	:	76205-7589
Country	:	US
Telephone Number	:	940-565-0155
Fax Number	:	940-565-5005

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

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	08/28/2012

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