Provider Demographics
NPI:1669600110
Name:LEAL, FLOR VANESSA (PHD)
Entity type:Individual
Prefix:
First Name:FLOR
Middle Name:VANESSA
Last Name:LEAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:FLOR
Other - Middle Name:VANESSA
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1551 OAK LAWN AVE
Mailing Address - Street 2:APT 276
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3746
Mailing Address - Country:US
Mailing Address - Phone:214-400-7181
Mailing Address - Fax:
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:214-590-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist