Provider Demographics
NPI:1871782094
Name:HUNDRICH-SOURIS, CAROLA (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLA
Middle Name:
Last Name:HUNDRICH-SOURIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 SAN JACINTO BLVD
Mailing Address - Street 2:SUITE 355
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7589
Mailing Address - Country:US
Mailing Address - Phone:940-565-0155
Mailing Address - Fax:940-565-5005
Practice Address - Street 1:2220 SAN JACINTO BLVD
Practice Address - Street 2:SUITE 355
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7589
Practice Address - Country:US
Practice Address - Phone:940-565-0155
Practice Address - Fax:940-565-5005
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-6863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00750HMedicare PIN