Provider Demographics
NPI:1942437272
Name:ANDREA T VANDERPOOL, PH.D., PLLC
Entity Type:Organization
Organization Name:ANDREA T VANDERPOOL, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:T
Authorized Official - Last Name:VANDERPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-722-1711
Mailing Address - Street 1:2255 RIDGE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5155
Mailing Address - Country:US
Mailing Address - Phone:972-722-1711
Mailing Address - Fax:972-722-1711
Practice Address - Street 1:2255 RIDGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5155
Practice Address - Country:US
Practice Address - Phone:972-722-1711
Practice Address - Fax:972-722-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33850103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty