Illuminate Psychological Services DFW, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

ILLUMINATE PSYCHOLOGICAL SERVICES DFW, PLLC

Practice address

3605 Yucca Dr Ste 202
Flower Mound, TX 75028-2753

Phone

(940) 368-8497

NPI assigned

Jan 30, 2022

Organization subpart

No

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

Authorized official

Name

Kristin Harris-McDonaldNPI 1568115657

Title

Licensed Psychologist

Phone

(940) 368-8497

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristin Corey Harris-McDonald

  • Counseling Psychologist
  • Flower Mound, TX
  • NPI 1568115657
  NPD Authorized official

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

{
    "created_epoch": "1643500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643500800000",
    "number": "1649923731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760534974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 YUCCA DR STE 202",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750282753",
            "telephone_number": "940-368-8497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE PSYCHOLOGICAL SERVICES DFW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-30",
        "last_updated": "2022-01-30",
        "certification_date": "2022-01-30",
        "status": "A",
        "authorized_official_last_name": "HARRIS-MCDONALD",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "940-368-8497"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Flower Mound, TX
• Providers in Flower Mound, TX by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2022; 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.