Provider Demographics
NPI:1134450208
Name:SOUZA, PRISCILLA DREW (PHD LIC PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:DREW
Last Name:SOUZA
Suffix:
Gender:F
Credentials:PHD LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 LONE STAR DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-6326
Mailing Address - Country:US
Mailing Address - Phone:214-424-5764
Mailing Address - Fax:
Practice Address - Street 1:2600 LONE STAR DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-6326
Practice Address - Country:US
Practice Address - Phone:214-424-5764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9940101YA0400X
TX32008103TC0700X
VA0810002647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)