Provider Demographics
NPI:1659732717
Name:DALLAS PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:DALLAS PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:4696-197-5081
Mailing Address - Street 1:11551 FOREST CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3920
Mailing Address - Country:US
Mailing Address - Phone:469-751-2623
Mailing Address - Fax:
Practice Address - Street 1:11551 FOREST CENTRAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3920
Practice Address - Country:US
Practice Address - Phone:469-751-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty