Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2-2616 | TX |
N | 103TC0700X | Clinical Psychologist | 2-2616 | TX |
N | 103G00000X | Clinical Psychologist | 2-2616 | TX |
N | 103TC0700X | Clinical Psychologist | 2-2616 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2-2616 | TX |
NPI | 1023157666 |
---|---|
Provider Name | Janice Nici |
First Address | Dallas, TX 75231-5027 |
Second Address | Dallas, TX 75231-5027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |