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
Phone: (817) 442-1707
Fax: (817) 424-8428
Website:
Health care specialties
| Specialty | Code | License # | 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 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336156975 | NPPES |
| Texas | MEDICAID | 00K03H |
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