Organization
NICOLE BEREOLOS, PHD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE BEREOLOS (OWNER)
(972) 768-7994
Entity
Organization
Contact information
Practice address
9330 LBJ FWY STE 900, DALLAS, TX 75243-3443
(972) 768-7994
Mailing address
2033 W MCDERMOTT DR, STE 320, #184, ALLEN, TX 75013-4675
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012XH
BCBS
—
01
—
1427341825
NPI
—
05
—
289346301
—
TX
01
—
3809908
CIGNA
—
01
—
60054
AETNA
—
01
—
600766136
MAGELLAN
—
Enumeration date
05/23/2018
Last updated
05/23/2018
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