MEDICARE: METROPLEX MENTAL HEALTH, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1285294256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPLEX MENTAL HEALTH, PLLC

Provider Business Mailing Address
First Line	:	2315 ROOSEVELT DR STE B
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-5888
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 AIRPORT FWY STE 110
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117-6257
Country	:	US
Telephone Number	:	682-717-1111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WESLEY PARKS
Credential	:	LPC, NCC
Telephone Number	:	682-717-1111

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	06/20/2019

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