1053686360 NPI number — ASHWORTH PSYCHOLOGICAL SERVICES, PLLC

Table of content: (NPI 1053686360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053686360 NPI number — ASHWORTH PSYCHOLOGICAL SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHWORTH PSYCHOLOGICAL SERVICES, PLLC
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:
Provider Other Organization Name Type Code:
6
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:
1053686360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3330 N. GALLOWAY AVE.
Provider Second Line Business Mailing Address:
SUITE 304, BOX 17
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75150-4728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-390-3411
Provider Business Mailing Address Fax Number:
214-666-4208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8344 E R L THORNTON FWY
Provider Second Line Business Practice Location Address:
SUITE 410-B
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75228-7136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-390-3411
Provider Business Practice Location Address Fax Number:
214-666-4208
Provider Enumeration Date:
03/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ASHWORTH
Authorized Official First Name:
JANET
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER/PSYCHOLOGIST
Authorized Official Telephone Number:
214-390-3411

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  15755 , 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)

  • Identifier: 031318101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com