Provider Demographics
NPI:1922317858
Name:HEALTH PSYCHOLOGY CENTER LLC
Entity Type:Organization
Organization Name:HEALTH PSYCHOLOGY CENTER LLC
Other - Org Name:BEHAVIORAL HEALTH PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-361-2100
Mailing Address - Street 1:10355 TEXAS HIGHWAY 154 S
Mailing Address - Street 2:
Mailing Address - City:YANTIS
Mailing Address - State:TX
Mailing Address - Zip Code:75497-7475
Mailing Address - Country:US
Mailing Address - Phone:214-692-6666
Mailing Address - Fax:469-587-8439
Practice Address - Street 1:7557 RAMBLER RD
Practice Address - Street 2:SUITE 740
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4142
Practice Address - Country:US
Practice Address - Phone:214-361-2100
Practice Address - Fax:214-361-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33427103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty