Provider Demographics
NPI:1255411310
Name:DFW PSYCHOLOGICAL & CONSULTING SERVICES, INC.
Entity type:Organization
Organization Name:DFW PSYCHOLOGICAL & CONSULTING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EITEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-905-1277
Mailing Address - Street 1:700 NE LOOP 820
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4634
Mailing Address - Country:US
Mailing Address - Phone:817-905-1277
Mailing Address - Fax:817-887-5821
Practice Address - Street 1:700 NE LOOP 820
Practice Address - Street 2:SUITE 200A
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4634
Practice Address - Country:US
Practice Address - Phone:817-905-1277
Practice Address - Fax:817-887-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31363103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178841601Medicaid
TX87118AOtherBLUE CROSS BLUE SHIELD
TX00814ZMedicare ID - Type Unspecified