NPIMap

Organization Active NPI

Psylrw, Inc

  • Clinical Psychologist
  • Waco, TX
National Provider Identifier
1205161650
Registry record updated Oct 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
25008 Issued in TX
Legal business name
PSYLRW, INC
Practice address
6001 W Waco Dr Ste M
Waco, TX 76710-6309
Phone
(254) 772-8055
Fax
(254) 772-3019
NPI assigned
Oct 2, 2009
Last updated
Oct 2, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Ruth Wright, ED.D.NPI 1295777134
Title
Psychologist
Phone
(254) 772-8055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 25008 TX Primary

Addresses

Primary practice location

6001 W Waco Dr Ste M
Waco, TX 76710-6309

Mailing address

6001 W Waco Dr Ste M
Waco, TX 76710-6309
Phone (254) 772-8055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091014000704 TX Part B Supplier - Clinic/Group Practice 9830235233 Receives reassigned benefits from 1 practitioner
Practice locations: Waco, TX

National Provider Directory

National Provider Directory

Locations

6001 W Waco Dr
Ste M
Waco, TX 76710
Phone (254) 772-8055

710 N 64th St
Waco, TX 76710
Phone (254) 235-7604

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254441600000",
    "number": "1205161650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6001 W WACO DR STE M",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767106309",
            "telephone_number": "254-772-8055",
            "fax_number": "254-772-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6001 W WACO DR STE M",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767106309",
            "telephone_number": "254-772-8055",
            "fax_number": "254-772-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYLRW, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-02",
        "last_updated": "2009-10-02",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "254-772-8055",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "25008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.