Provider Demographics
NPI:1477721264
Name:PSYCHOTHERAPY AND GROWTH CLINIC OF DALLAS PC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY AND GROWTH CLINIC OF DALLAS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMSANY
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC LMFT
Authorized Official - Phone:972-458-2656
Mailing Address - Street 1:12890 HILLCREST RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-458-2656
Mailing Address - Fax:972-702-9428
Practice Address - Street 1:12890 HILLCREST RD
Practice Address - Street 2:STE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-458-2656
Practice Address - Fax:972-702-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3616101YP2500X
TX1804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty