| Davenport Diagnostic And Treatment Center, Inc | |
|
14275 Midway Rd Suite 220 Addison TX 75001-3614 | |
| (972) 850-0720 | |
| Not Available |
| Full Name | Davenport Diagnostic And Treatment Center, Inc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 14275 Midway Rd, Addison, Texas |
| Authorized Official Name and Position | Kimberly C Johnson (PSYCOLOGIST) |
| Authorized Official Contact | 9728500720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Davenport Diagnostic And Treatment Center, Inc 14275 Midway Rd Suite 220 Addison TX 75001-3614 Ph: (972) 850-0720 | Davenport Diagnostic And Treatment Center, Inc 14275 Midway Rd Suite 220 Addison TX 75001-3614 Ph: (972) 850-0720 |
| NPI Number | 1255578191 |
|---|---|
| Provider Enumeration Date | 01/14/2009 |
| Last Update Date | 01/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255578191 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 32578 (Texas) | Primary |
| 103TS0200X | Psychologist - School | 32698 (Texas) | Secondary |
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