Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 23065 | TX |
Y | 103T00000X | Psychologist | 23065 | TX |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 23065 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 23065 | TX |
NPI | 1013078963 |
---|---|
Provider Name | Dorthy Floyd |
First Address | Terrell, TX 75160-9000 |
Second Address | Terrell, TX 75160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23065 | TX ST BOARD OF EXAM (01) | TX |