Provider Demographics
NPI:1215351010
Name:WHITE ROCK PSYCHIATRIC AND PSYCHOTHERAPY SERVICES
Entity type:Organization
Organization Name:WHITE ROCK PSYCHIATRIC AND PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-728-9080
Mailing Address - Street 1:7952 BRIAR BROOK CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4514
Mailing Address - Country:US
Mailing Address - Phone:214-728-9080
Mailing Address - Fax:469-249-1059
Practice Address - Street 1:1350 N BUCKNER BLVD
Practice Address - Street 2:214
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3500
Practice Address - Country:US
Practice Address - Phone:214-321-2500
Practice Address - Fax:469-249-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL24962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18552528782Medicare UPIN