Provider Demographics
NPI:1154812048
Name:DENTON INTEGRATIVE PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:DENTON INTEGRATIVE PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNDRICH-SOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:940-565-0155
Mailing Address - Street 1:2220 SAN JACINTO BLVD STE 355
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7591
Mailing Address - Country:US
Mailing Address - Phone:940-565-0155
Mailing Address - Fax:
Practice Address - Street 1:2220 SAN JACINTO BLVD
Practice Address - Street 2:SUITE 355
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7591
Practice Address - Country:US
Practice Address - Phone:940-565-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-6863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty