Provider Demographics
NPI:1801001110
Name:RILLING, LAURIE MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:MICHELLE
Last Name:RILLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 GRANITE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6622
Mailing Address - Country:US
Mailing Address - Phone:972-731-6985
Mailing Address - Fax:972-731-6986
Practice Address - Street 1:5700 GRANITE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6622
Practice Address - Country:US
Practice Address - Phone:972-731-6985
Practice Address - Fax:972-731-6986
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33537103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist