Provider Demographics
NPI:1790050375
Name:DR ASSOCIATES OF NORTH TEXAS
Entity Type:Organization
Organization Name:DR ASSOCIATES OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROCHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-612-1305
Mailing Address - Street 1:2301 OHIO DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3927
Mailing Address - Country:US
Mailing Address - Phone:972-612-1305
Mailing Address - Fax:972-867-3402
Practice Address - Street 1:2301 OHIO DR
Practice Address - Street 2:SUITE 130
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3927
Practice Address - Country:US
Practice Address - Phone:972-612-1305
Practice Address - Fax:972-867-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15435103G00000X
TX23838103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty