Provider Demographics
NPI:1548746753
Name:MASSEY, REVIS ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:REVIS ANN
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 CHAPEL HILL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4750
Mailing Address - Country:US
Mailing Address - Phone:786-543-2428
Mailing Address - Fax:
Practice Address - Street 1:2150 LAKESIDE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4467
Practice Address - Country:US
Practice Address - Phone:786-543-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical