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Organization

REBECCA FONVILLE PSYD LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. REBECCA FONVILLE PSYD (CLINICAL PSYCHOLOGY)
(773) 809-4077
Entity
Organization

Contact information

Practice address
12801 N CENTRAL EXPY STE 1730, DALLAS, TX 75243-1872
(773) 809-4077
Mailing address
12801 N CENTRAL EXPY STE 1730, DALLAS, TX 75243-1872
(773) 809-4077

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary

Other

Enumeration date
03/28/2024
Last updated
03/28/2024
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