Provider Demographics
NPI:1154970085
Name:NORTH TEXAS ADOLESCENT AND YOUNG ADULT PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:NORTH TEXAS ADOLESCENT AND YOUNG ADULT PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-763-9595
Mailing Address - Street 1:PO BOX 250913
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0913
Mailing Address - Country:US
Mailing Address - Phone:972-299-0127
Mailing Address - Fax:844-809-6223
Practice Address - Street 1:8668 JOHN HICKMAN PKWY STE 601
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9385
Practice Address - Country:US
Practice Address - Phone:972-299-0127
Practice Address - Fax:844-809-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty