Individual
MARK S RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
558 SILICON DR, #102, SOUTHLAKE, TX 76092-7529
(817) 442-1707
(817) 424-8428
Mailing address
558 SILICON DR, #102, SOUTHLAKE, TX 76092-7529
(817) 442-1707
(817) 424-8428
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
24516
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00K03H
—
TX
Enumeration date
08/02/2006
Last updated
06/08/2009
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