1003128158 NPI number — MRS. EMILY DIANNE HEAD MS, LPC

Table of content: MRS. EMILY DIANNE HEAD MS, LPC (NPI 1003128158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003128158 NPI number — MRS. EMILY DIANNE HEAD MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEAD
Provider First Name:
EMILY
Provider Middle Name:
DIANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1003128158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3630 FM 2181
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
HICKORY CREEK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75065-7646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-535-4824
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3630 FM 2181
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HICKORY CREEK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75065-7646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-535-4824
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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