Provider Demographics
NPI:1093029951
Name:EAST TEXAS PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:EAST TEXAS PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-675-9570
Mailing Address - Street 1:700 S PALESTINE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3325
Mailing Address - Country:US
Mailing Address - Phone:903-675-9570
Mailing Address - Fax:903-675-9577
Practice Address - Street 1:700 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3325
Practice Address - Country:US
Practice Address - Phone:903-675-9570
Practice Address - Fax:903-675-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty