Provider Demographics
NPI:1538256771
Name:NORTH DALLAS PSYCHOLOGICAL PRACTICE
Entity type:Organization
Organization Name:NORTH DALLAS PSYCHOLOGICAL PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:RAVELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-231-1211
Mailing Address - Street 1:6330 LBJ FWY STE 236
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6431
Mailing Address - Country:US
Mailing Address - Phone:972-231-1211
Mailing Address - Fax:972-231-1211
Practice Address - Street 1:6330 LBJ FWY STE 236
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6431
Practice Address - Country:US
Practice Address - Phone:972-231-1211
Practice Address - Fax:972-231-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00451YMedicare ID - Type UnspecifiedGROUP NUMBER