Provider Demographics
NPI:1538653753
Name:MANJU R. GOYAL M.D. PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:MANJU R. GOYAL M.D. PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANJU
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-403-8035
Mailing Address - Street 1:5477 GLEN LAKES DR STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4375
Mailing Address - Country:US
Mailing Address - Phone:972-598-0285
Mailing Address - Fax:972-598-0287
Practice Address - Street 1:5477 GLEN LAKES DR STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:972-598-0285
Practice Address - Fax:972-598-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG23782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty