Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | TX2943 | TX |
Y | 103TC0700X | Clinical Psychologist | TX2943 | TX |
NPI | 1003824343 |
---|---|
Provider Name | Valette ----------- Liedtkehendrickson |
First Address | Hurst, TX 76054-2943 |
Second Address | Hurst, TX 76054-2943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |