Individual
DR. AILEEN FULLCHANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
3500 OAK LAWN AVE STE 230, DALLAS, TX 75219-4369
(214) 247-6410
Mailing address
2807 THROCKMORTON ST APT 101, DALLAS, TX 75219-6204
(510) 685-8593
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
37995
TX
103TC2200X
Clinical Child & Adolescent Psychologist
37995
TX
103TF0000X
Family Psychologist
37995
TX
103TH0100X
Health Service Psychologist
37995
TX
Other
Enumeration date
12/04/2019
Last updated
12/04/2019
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