Provider Demographics
NPI:1235390600
Name:DRIES, DENA ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:ANN
Last Name:DRIES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:DRIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1109 CHEEK SPARGER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:617-957-9665
Mailing Address - Fax:
Practice Address - Street 1:1109 CHEEK SPARGER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:617-957-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX38079103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program