NPI 1629372115 · live from the CMS NPI Registry
Olga Vadymovna Berkout, PHD
Psychologist in Tyler, TX. National Provider Identifier 1629372115, active.
NPI record
| NPI | 1629372115 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist 103T00000X |
| Practice location | 2935 Bain Pl, Tyler, TX 75701 |
| Practice phone | 662-613-0008 |
| Mailing address | 34 County Road 7283, Jonesboro, AR 72405 |
| Enumerated | December 27, 2010 |
| Last updated | June 8, 2021 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist primary | 103T00000X | 37551 (TX) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.