Provider Demographics
NPI:1861151151
Name:SPENCER, BECKY SUE (PHD, APRN, PMHNP)
Entity type:Individual
Prefix:DR
First Name:BECKY
Middle Name:SUE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PHD, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 YARDLEY CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2138
Mailing Address - Country:US
Mailing Address - Phone:972-400-8985
Mailing Address - Fax:
Practice Address - Street 1:2560 CENTRAL PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1566
Practice Address - Country:US
Practice Address - Phone:972-777-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1060863363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health