Provider Demographics
NPI: | 1629288832 |
---|---|
Name: | GARLAND PSYCHOLOGICAL CENTER |
Entity Type: | Organization |
Organization Name: | GARLAND PSYCHOLOGICAL CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ZIEGLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 972-272-1633 |
Mailing Address - Street 1: | 2301 FOREST LN |
Mailing Address - Street 2: | SUITE 400 |
Mailing Address - City: | GARLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75042-7954 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-272-1633 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 14637 PEBBLE BEND DR |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77068-2922 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-484-8400 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-23 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | PSY21667TX | 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty |