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Organization
SOURCE ONE NORTH PLANO LLC
Active
Organization
SOURCE ONE NORTH PLANO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM GARRET HARRELL (CHIEF OPERATIONS OFFICER)
(214) 808-2724
Entity
Organization
Contact information
Practice address
8080 INDEPENDENCE PKWY STE 110A, PLANO, TX 75025-4000
(972) 801-2190
(972) 801-2191
Mailing address
PO BOX 251728, PLANO, TX 75025-1517
(972) 801-2190
(972) 801-2191
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TE1100X
Exercise & Sports Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
Other
Enumeration date
05/02/2024
Last updated
05/02/2024
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