| Psychology Professionals Of Northeast Texas | |
|
3605 Ne Loop 286 Ste 200 Paris TX 75460-5091 | |
| (903) 989-7202 | |
| Not Available |
| Full Name | Psychology Professionals Of Northeast Texas |
|---|---|
| Speciality | Psychologist |
| Location | 3605 Ne Loop 286 Ste 200, Paris, Texas |
| Authorized Official Name and Position | Ryan Ray Cooper (OWNER) |
| Authorized Official Contact | 9039897202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychology Professionals Of Northeast Texas 3605 Ne Loop 286 Ste 200 Paris TX 75460-5091 Ph: (903) 989-7202 | Psychology Professionals Of Northeast Texas 3605 Ne Loop 286 Ste 200 Paris TX 75460-5091 Ph: (903) 989-7202 |
| NPI Number | 1568108363 |
|---|---|
| Provider Enumeration Date | 05/05/2022 |
| Last Update Date | 12/27/2022 |
| Certification Date | 12/27/2022 |
| Medicare PECOS PAC ID | 5496139917 |
|---|---|
| Medicare Enrollment ID | O20220901002337 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568108363 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ryan Ray Cooper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588222111 PECOS PAC ID: 6305220823 Enrollment ID: I20220901002463 |
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