Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 31748 | TX |
N | 103G00000X | Clinical Psychologist | 31748 | TX |
N | 103TC0700X | Clinical Psychologist | 31748 | TX |
NPI | 1598796377 |
---|---|
Provider Name | Dr. Patricia K. Jackley |
First Address | Dallas, TX 75214-3965 |
Second Address | Dallas, TX 75216-7167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |