Provider Demographics
NPI:1548650070
Name:IRVINE, VERONICA (LPA)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:IRVINE
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9262 FOREST LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:214-692-5001
Mailing Address - Fax:214-692-5750
Practice Address - Street 1:9262 FOREST LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:214-692-5001
Practice Address - Fax:214-692-5750
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX33250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist