Individual
DR. MICHELLE BENGTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 E SOUTHLAKE BLVD STE 190, SOUTHLAKE, TX 76092-6351
(817) 251-0911
Mailing address
425 E BOB JONES RD, ROANOKE, TX 76262-9216
(817) 491-2481
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
30853
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30853
LICENSE-PSYCHOLOGY
TX
Enumeration date
09/26/2006
Last updated
07/08/2007
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