Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 24754 | TX |
Y | 103T00000X | Psychologist | 24754 | TX |
N | 103G00000X | Clinical Psychologist | 24754 | TX |
N | 103TC0700X | Clinical Psychologist | 24754 | TX |
N | 103TH0100X | Health Service | PSY 21235 | CA |
NPI | 1598896854 |
---|---|
Provider Name | Dr. Judy Embry |
First Address | Dallas, TX 75284-4658 |
Second Address | Killeen, TX 76543-5252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 20/03/2017 |