Provider Demographics
NPI:1306205588
Name:MONTEREY PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:MONTEREY PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:469-519-2782
Mailing Address - Street 1:945 STOCKTON DR UNIT 3130
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6157
Mailing Address - Country:US
Mailing Address - Phone:469-291-9009
Mailing Address - Fax:866-433-3741
Practice Address - Street 1:945 STOCKTON DR UNIT 3130
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6157
Practice Address - Country:US
Practice Address - Phone:469-291-9009
Practice Address - Fax:866-433-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL159107Medicaid
AL158667Medicaid
AL158667Medicaid
TX102I684376Medicare UPIN
AL159107Medicaid