Provider Demographics
NPI:1851445324
Name:THULL, SANDRA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:THULL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 N HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-3106
Mailing Address - Country:US
Mailing Address - Phone:972-839-0983
Mailing Address - Fax:214-941-1908
Practice Address - Street 1:834 N HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-3106
Practice Address - Country:US
Practice Address - Phone:972-839-0983
Practice Address - Fax:214-941-1908
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1409567Medicaid