Provider Demographics
NPI:1386288405
Name:RICE, TINA MAE (PSYD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MAE
Last Name:RICE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MAE
Other - Last Name:LANGERUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2990 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6066
Mailing Address - Country:US
Mailing Address - Phone:972-510-7750
Mailing Address - Fax:
Practice Address - Street 1:2990 LEGACY DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6066
Practice Address - Country:US
Practice Address - Phone:972-510-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38269103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38269OtherPSYCHOLOGIST LICENSE