Provider Demographics
NPI:1538656483
Name:MCNICHOL PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:MCNICHOL PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNICHOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-308-2115
Mailing Address - Street 1:1420 W EXCHANGE PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4697
Mailing Address - Country:US
Mailing Address - Phone:214-308-2115
Mailing Address - Fax:
Practice Address - Street 1:1420 W EXCHANGE PKWY STE 140
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4697
Practice Address - Country:US
Practice Address - Phone:214-308-2115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty