Provider Demographics
NPI:1306073937
Name:EGYED, CARLA J (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:EGYED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 GUADALOUPE
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6732
Mailing Address - Country:US
Mailing Address - Phone:214-886-1814
Mailing Address - Fax:817-473-8310
Practice Address - Street 1:3108 GUADALOUPE
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6732
Practice Address - Country:US
Practice Address - Phone:214-886-1814
Practice Address - Fax:817-473-8310
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34047103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist