Therlively
Psychologist, Clinical in Southlake, TX. Organization (NPI-2).
NPI number1063282929
StatusActive
Last updated in NPPESJan 16, 2024
Details
- NPI
- 1063282929
- Entity type
- Organization (NPI-2)
- Legal business name
- Therlively
- Organization subpart
- No
- Enumeration date
- Jan 3, 2024
- Certification date
- Jan 16, 2024
- Last updated
- Jan 16, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | – | – | Yes |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – |
Practice location
1340 N White Chapel Blvd Ste 130Southlake, TX 76092-4327
Phone 817-381-5259
Mailing address
1340 N White Chapel Blvd Ste 130Southlake, TX 76092-4327
Phone 817-381-5259
Authorized official
Andrea Kirby
Clinical Psychologist
8173815259
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