Provider Demographics
NPI:1518175595
Name:DARTSON, MYRNA VANESSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:VANESSA
Last Name:DARTSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4101 MCEWEN RD STE 625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5224
Mailing Address - Country:US
Mailing Address - Phone:214-219-1116
Mailing Address - Fax:214-219-1120
Practice Address - Street 1:4101 MCEWEN RD STE 625
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5224
Practice Address - Country:US
Practice Address - Phone:214-219-1116
Practice Address - Fax:214-219-1120
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154248201Medicaid
TX6210885084OtherMEDICARE