Provider Demographics
NPI:1104127752
Name:HETHERLY, JAMES HEATH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HEATH
Last Name:HETHERLY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 MEADOW RD
Mailing Address - Street 2:SUITE #134
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3769
Mailing Address - Country:US
Mailing Address - Phone:214-559-5700
Mailing Address - Fax:
Practice Address - Street 1:8340 MEADOW RD
Practice Address - Street 2:SUITE #134
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3769
Practice Address - Country:US
Practice Address - Phone:214-559-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical