Provider Demographics
NPI:1730568817
Name:LARERY-DVALI PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:LARERY-DVALI PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:832-794-7513
Mailing Address - Street 1:52 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:STE. 300
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2206
Mailing Address - Country:US
Mailing Address - Phone:713-900-5557
Mailing Address - Fax:713-900-5557
Practice Address - Street 1:52 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2206
Practice Address - Country:US
Practice Address - Phone:713-900-5557
Practice Address - Fax:713-900-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34051103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty