Provider Demographics
NPI:1164145769
Name:TEXAS CHILD PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:TEXAS CHILD PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP, NCSP
Authorized Official - Phone:817-381-6298
Mailing Address - Street 1:6433 DOLAN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2560
Mailing Address - Country:US
Mailing Address - Phone:210-865-4010
Mailing Address - Fax:
Practice Address - Street 1:532 SILICON DR STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9018
Practice Address - Country:US
Practice Address - Phone:817-381-6298
Practice Address - Fax:817-381-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty