Premier Psychology Consultants PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

PREMIER PSYCHOLOGY CONSULTANTS PLLC

Practice address

1725 E Southlake Blvd Ste 102
Southlake, TX 76092-6457

Phone

(682) 477-4400

NPI assigned

Dec 5, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Marietta Richard, PH.D.NPI 1699950782

Title

PH.D. / Psychologist

Phone

(682) 477-4400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

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

• Marietta Baccus Richard, PH.D

  • Clinical Psychologist
  • Southlake, TX
  • NPI 1699950782
  Medicare reassignment NPD Authorized official
• Kevin Stice, D.C.

  • Chiropractor
  • Southlake, TX
  • NPI 1033414685
  NPD (past)

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

{
    "created_epoch": "1543968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561680000000",
    "number": "1942771787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 E SOUTHLAKE BLVD",
            "address_2": "SUITE 102",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "682-477-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 E SOUTHLAKE BLVD STE 102",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926457",
            "telephone_number": "682-477-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PSYCHOLOGY CONSULTANTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-05",
        "last_updated": "2019-06-28",
        "status": "A",
        "authorized_official_last_name": "RICHARD",
        "authorized_official_first_name": "MARIETTA",
        "authorized_official_title_or_position": "PH.D. / PSYCHOLOGIST",
        "authorized_official_telephone_number": "682-477-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Southlake, TX
• Providers in Southlake, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; 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.