Provider Demographics
NPI:1326613373
Name:OLDHAM, ELLEN (PSYD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 ABRAMS RD STE 325
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5579
Mailing Address - Country:US
Mailing Address - Phone:469-619-7622
Mailing Address - Fax:
Practice Address - Street 1:1221 ABRAMS RD STE 325
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5579
Practice Address - Country:US
Practice Address - Phone:469-619-7622
Practice Address - Fax:469-458-7024
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist