Unknown Individual – Clinical Psychologist, NPI 1689754541

Clinical Psychologist

Unknown Individual is a healthcare provider. based in Southlake, Texas. specializing in Clinical Psychologist. They hold a License No. 22218 (TX). The NPI Number for Unknown Individual is 1689754541

Main info

Organization

Inactive

47 Years Of Experience

Name

Unknown Individual

NPI

1689754541

Phone

(214) 755-4925

Address

2485 E SOUTHLAKE BLVD STE 180

Deactivation Date

21 July 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2147554925

Graduation Year

1979 (47 years ago)

PAC ID

4981881455

Professional Enrollment ID

I20110609000402

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

180, East Southlake Boulevard, Park Village, Southlake, Tarrant County, Texas, 76092, United States
SOUTHLAKE, TX 760926687
Phone: (214) 755-4925
Fax: (817) 488-9656
Type: Mailing
1200 E Collins Blvd
# 300
Richardson, TX 75081
Phone: (972) 669-1733
Fax: (972) 669-1403
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76092)

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Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?

Yes. Unknown Individual is listed with NPI 1689754541 in the public NPI dataset.

Is Unknown Individual excluded from programs when inactive?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Clinical Psychologist in this dataset. Clinical services aligned with this taxonomy classification.

Where should I expect Unknown Individual on a map?

Expect Southlake, Texas as a primary anchor for Unknown Individual unless the record lists multiple sites.

Is the information about Unknown Individual up to date?

Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."