Basic Information
| Provider Information | |||||||||
| NPI: | 1235374653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIETZ | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 BUR OAK DR | ||||||||
| Address2: | |||||||||
| City: | COLLEYVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760345986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166808399 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12700 HILLCREST RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752302033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725731010 | ||||||||
| FaxNumber: | 9722331099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2008 | ||||||||
| LastUpdateDate: | 12/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 33235 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.