Davenport Diagnostic and Treatment Center, Inc

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

32578 Issued in TX

Legal business name

DAVENPORT DIAGNOSTIC AND TREATMENT CENTER, INC

Practice address

14275 Midway Rd
Suite 220
Addison, TX 75001-3614

Phone

(972) 850-0720

NPI assigned

Jan 14, 2009

Last updated

Jan 14, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly C Johnson, PSYD

Title

Psycologist

Phone

(972) 850-0720

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231891200000",
    "number": "1255578191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD",
            "address_2": "SUITE 220",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013614",
            "telephone_number": "972-850-0720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD",
            "address_2": "SUITE 220",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013614",
            "telephone_number": "972-850-0720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT DIAGNOSTIC AND TREATMENT CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-14",
        "last_updated": "2009-01-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PSYCOLOGIST",
        "authorized_official_telephone_number": "972-850-0720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "32578",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": "TX",
            "license": "32698",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Johan Daniel
• David Barnett, MD PA
• Lauren Ann Davidson, LMSW
• Christy Davila, COTA
• Monique Davis
• Stacy Davis, PT, DPT

• Clinical Neuropsychologist in Addison, TX
• Providers in Addison, TX by specialty
• Clinical Neuropsychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.