Provider Demographics
NPI:1770054165
Name:PSYCHOLOGICAL TESTING SERVICES OF DALLAS, PLLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL TESTING SERVICES OF DALLAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-532-9282
Mailing Address - Street 1:1400 PRESTON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3603
Mailing Address - Country:US
Mailing Address - Phone:972-532-9282
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESTON RD STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3603
Practice Address - Country:US
Practice Address - Phone:972-532-9282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty