Provider Demographics
NPI:1073789459
Name:FAVRE, TRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:
Last Name:FAVRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OHIO DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3927
Mailing Address - Country:US
Mailing Address - Phone:972-612-1188
Mailing Address - Fax:972-612-8040
Practice Address - Street 1:2301 OHIO DR
Practice Address - Street 2:SUITE 135
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3927
Practice Address - Country:US
Practice Address - Phone:972-612-1188
Practice Address - Fax:972-612-8040
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2016-02-19
Deactivation Date:2016-02-15
Deactivation Code:
Reactivation Date:2016-02-19
Provider Licenses
StateLicense IDTaxonomies
TX32265103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent