| Cook Children's Medical Center | |
|
1500 Cooper St Fort Worth TX 76104-2710 | |
| (682) 303-9200 | |
| (682) 303-9239 |
| Full Name | Cook Children's Medical Center |
|---|---|
| Speciality | Psychologist - Intellectual & Developmental Disabilities |
| Location | 1500 Cooper St, Fort Worth, Texas |
| Authorized Official Name and Position | Cory R Rhoades (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6828854480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cook Children's Medical Center Po Box 99213 Fort Worth TX 76199-0213 Ph: (682) 885-1860 | Cook Children's Medical Center 1500 Cooper St Fort Worth TX 76104-2710 Ph: (682) 303-9200 |
| NPI Number | 1164105458 |
|---|---|
| Provider Enumeration Date | 08/11/2023 |
| Last Update Date | 08/11/2023 |
| Certification Date | 08/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164105458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 103TM1800X | Psychologist - Intellectual & Developmental Disabilities | (* (Not Available)) | Primary |
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