Provider Demographics
NPI:1639757362
Name:MOONEY-HOLMES, DEIRDRE NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:NICOLE
Last Name:MOONEY-HOLMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3605 YUCCA DR STE 202
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2753
Mailing Address - Country:US
Mailing Address - Phone:469-431-5616
Mailing Address - Fax:
Practice Address - Street 1:3605 YUCCA DR STE 202
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2753
Practice Address - Country:US
Practice Address - Phone:469-431-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33601103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist