Provider Demographics
NPI:1073909438
Name:PSYCHOLOGICAL SERVICES OF NORTH TEXAS, PLLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF NORTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NADELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:972-445-9340
Mailing Address - Street 1:7135 COLLEYVILLE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7135 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6240
Practice Address - Country:US
Practice Address - Phone:817-416-7169
Practice Address - Fax:817-416-7175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36072103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX415784Medicare PIN