Provider Demographics
NPI:1548340417
Name:MOODY, TERRY J (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:J
Last Name:MOODY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E COLLINS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081
Mailing Address - Country:US
Mailing Address - Phone:972-669-1733
Mailing Address - Fax:972-669-1403
Practice Address - Street 1:1200 E COLLINS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081
Practice Address - Country:US
Practice Address - Phone:972-669-1733
Practice Address - Fax:972-669-1403
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22786103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist