Provider Demographics
NPI:1124414115
Name:PARK CITIES CHILD AND ADOLESCENT PSYCHOLOGY
Entity Type:Organization
Organization Name:PARK CITIES CHILD AND ADOLESCENT PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:214-606-8141
Mailing Address - Street 1:4138 DRUID LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1143
Mailing Address - Country:US
Mailing Address - Phone:214-606-8141
Mailing Address - Fax:
Practice Address - Street 1:4138 DRUID LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1143
Practice Address - Country:US
Practice Address - Phone:214-606-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty