Provider Demographics
NPI:1558600767
Name:CEDAR HILL PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:CEDAR HILL PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:972-291-1001
Mailing Address - Street 1:PO BOX 1391
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-1391
Mailing Address - Country:US
Mailing Address - Phone:972-291-1001
Mailing Address - Fax:
Practice Address - Street 1:630 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2156
Practice Address - Country:US
Practice Address - Phone:972-291-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3310880-01Medicaid
=========OtherTRICARE SOUTH REGION
=========OtherTRICARE SOUTH REGION