Provider Demographics
NPI:1588061923
Name:PSYCHOLOGY ASSOCIATES OF EAST TEXAS, LLC.
Entity type:Organization
Organization Name:PSYCHOLOGY ASSOCIATES OF EAST TEXAS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-596-8118
Mailing Address - Street 1:2010 SYBIL LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1823
Mailing Address - Country:US
Mailing Address - Phone:903-596-8118
Mailing Address - Fax:903-596-8125
Practice Address - Street 1:2010 SYBIL LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1823
Practice Address - Country:US
Practice Address - Phone:903-596-8118
Practice Address - Fax:903-596-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty