Provider Demographics
NPI:1134306384
Name:RIDER, JAN KATHLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:KATHLEEN
Last Name:RIDER
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 1:12830 HILLCREST RD
Mailing Address - Street 2:SUITE D218
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1527
Mailing Address - Country:US
Mailing Address - Phone:469-791-9100
Mailing Address - Fax:469-791-9200
Practice Address - Street 1:12830 HILLCREST RD
Practice Address - Street 2:SUITE D218
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1527
Practice Address - Country:US
Practice Address - Phone:469-791-9100
Practice Address - Fax:469-791-9200
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist