Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 1-07-3381 | TX |
NPI | 1083817357 |
---|---|
Provider Name | Vicki Lynn Niedermayer |
First Address | Arlington, TX 76018-2384 |
Second Address | Arlington, TX 76018-2384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1-07-3381 | BOARD CERT. BEH.ANALYST (01) | TX |