Provider Demographics
NPI:1952062754
Name:CHILD PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CHILD PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-238-2873
Mailing Address - Street 1:12832 MODENA CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-6117
Mailing Address - Country:US
Mailing Address - Phone:425-238-2873
Mailing Address - Fax:425-309-5187
Practice Address - Street 1:107 LARSON LN STE 200
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-4593
Practice Address - Country:US
Practice Address - Phone:817-668-5056
Practice Address - Fax:817-476-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty