Active NPI
Mary Madison Eagle, PH.D.
- Clinical Psychologist
- Fort Worth, TX
National Provider Identifier
1639625171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 16-18P
- Practice address
- 4837 Bryce Ave
Fort Worth, TX 76107-4144 - Phone
- (817) 980-7474
- NPI assigned
- Aug 25, 2016
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 16-18P | AR | Primary |
Addresses
Primary practice location
4837 Bryce Ave
Fort Worth, TX 76107-4144
Mailing address
4837 Bryce Ave
Fort Worth, TX 76107-4144
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 |
|---|---|---|---|
| 16-18P | AR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472083200000",
"number": "1639625171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4837 BRYCE AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761074144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4837 BRYCE AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761074144",
"telephone_number": "817-980-7474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EAGLE",
"first_name": "MARY MADISON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-25",
"last_updated": "2016-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AR",
"license": "16-18P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.