Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 32265 | TX |
Y | 103TC0700X | Clinical Psychologist | 32265 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 32265 | TX |
NPI | 1073789459 |
---|---|
Provider Name | Dr. Tricia Favre |
First Address | Plano, TX 75093-3927 |
Second Address | Plano, TX 75093-3927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 19/02/2016 |