Provider Demographics
NPI:1144542572
Name:DEVELOPMENTAL NEUROPSYCHOLOGY SERVICES, PLLC
Entity type:Organization
Organization Name:DEVELOPMENTAL NEUROPSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-649-9207
Mailing Address - Street 1:1215 HALL JOHNSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7810
Mailing Address - Country:US
Mailing Address - Phone:214-649-9207
Mailing Address - Fax:817-428-9885
Practice Address - Street 1:1215 HALL JOHNSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7810
Practice Address - Country:US
Practice Address - Phone:214-649-9207
Practice Address - Fax:817-428-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31884103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty