Rider, Mark S

Rider, Mark S is an sole proprietor health care provider with primary practice located at 558 Silicon Dr #102, Southlake TX 76092-7529. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Rider, Mark S can be contacted via phone (817) 442-1707.

Contact Information

Primary practice address
558 Silicon Dr #102 Southlake TX 76092-7529
Fax: (817) 424-8428
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 24516 Texas

Profile Details

NPI number 1336156975
LBN Legal business name Rider, Mark S
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 2nd, 2006
Last updated Jun 8th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336156975 NPPES
Texas MEDICAID 00K03H

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