Active NPI
Evan Bodine, PH.D.
- Psychologist
- Dallas, TX
National Provider Identifier
1154896850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 37871
- Practice address
- 8140 Walnut Hill LN Ste 440
Dallas, TX 75231-4328 - Phone
- (972) 913-6879
- NPI assigned
- Oct 9, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 37871 | TX | Primary |
Addresses
Primary practice location
8140 Walnut Hill LN Ste 440
Dallas, TX 75231-4328
Mailing address
8140 Walnut Hill LN Ste 440
Dallas, TX 75231-4328
Phone (972) 913-6879
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37871 | TX | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539043200000",
"number": "1154896850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8140 WALNUT HILL LN STE 440",
"city": "DALLAS",
"state": "TX",
"postal_code": "752314328",
"telephone_number": "972-913-6879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8140 WALNUT HILL LN STE 440",
"city": "DALLAS",
"state": "TX",
"postal_code": "752314328",
"telephone_number": "972-913-6879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODINE",
"first_name": "EVAN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-09",
"last_updated": "2018-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": "TX",
"license": "37871",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.