Provider Demographics
NPI:1932162898
Name:ROCHELLE, GARY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:ROCHELLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2220 COIT RD
Mailing Address - Street 2:STE. 480, PMB 304
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3797
Mailing Address - Country:US
Mailing Address - Phone:214-498-9392
Mailing Address - Fax:972-596-0238
Practice Address - Street 1:2301 OHIO DR
Practice Address - Street 2:STE. 130
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3927
Practice Address - Country:US
Practice Address - Phone:214-498-9392
Practice Address - Fax:972-596-0238
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15435103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030388921OtherTRICARE PROVIDER NUMBER
TX0090HVOtherBCBS PROVIDER NUMBER
TX030388921OtherTAX ID
TX030388921OtherTAX ID
TX00547PMedicare PIN