Infinite Potential Behavioral Health Services, PLLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

34687 Issued in TX

Legal business name

INFINITE POTENTIAL BEHAVIORAL HEALTH SERVICES, PLLC

Practice address

4100 Spring Valley Rd Ste 320
Dallas, TX 75244-3629

Phone

(214) 396-9699

Fax

(844) 895-4585

NPI assigned

Aug 4, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Shalanda Nichelle Gordon, PH.D.

Title

Owner/Clinical Director

Phone

(214) 396-9699

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1501804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1750806311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 SPRING VALLEY RD STE 320",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443629",
            "telephone_number": "214-396-9699",
            "fax_number": "844-895-4585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 SPRING VALLEY RD STE 320",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443629",
            "telephone_number": "214-396-9699",
            "fax_number": "844-895-4585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITE POTENTIAL BEHAVIORAL HEALTH SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "SHALANDA",
        "authorized_official_middle_name": "NICHELLE",
        "authorized_official_title_or_position": "OWNER/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "214-396-9699",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "34687",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "TX",
            "license": "34687",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "34687",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.