Provider Demographics
NPI:1023432481
Name:DOCTHERESE PLLC
Entity type:Organization
Organization Name:DOCTHERESE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMIEC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-228-6819
Mailing Address - Street 1:6812 FAIR MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:N RICHLND HLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-7611
Mailing Address - Country:US
Mailing Address - Phone:817-228-6819
Mailing Address - Fax:866-801-2988
Practice Address - Street 1:6812 FAIR MEADOWS DR
Practice Address - Street 2:
Practice Address - City:N RICHLND HLS
Practice Address - State:TX
Practice Address - Zip Code:76182-7611
Practice Address - Country:US
Practice Address - Phone:817-228-6819
Practice Address - Fax:866-801-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23197103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty