Provider Demographics
NPI:1942717814
Name:TEXOMA PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:TEXOMA PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:903-462-0032
Mailing Address - Street 1:305 W WOODARD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-3136
Mailing Address - Country:US
Mailing Address - Phone:903-462-0032
Mailing Address - Fax:903-496-0713
Practice Address - Street 1:305 W WOODARD ST STE 201
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3136
Practice Address - Country:US
Practice Address - Phone:903-462-0032
Practice Address - Fax:903-496-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty