1457650277 NPI number — COMPREHENSIVE PSYCHOLOGICAL SERVICES PC

Table of content: (NPI 1457650277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457650277 NPI number — COMPREHENSIVE PSYCHOLOGICAL SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PSYCHOLOGICAL SERVICES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KRISTI DAWN ROPER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457650277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17304 PRESTON RD STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75252-5645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-763-1985
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17304 PRESTON RD STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75252-5645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-763-1985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROPER
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
214-763-1985

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  30752 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com