Healthcare Provider Details

I. General information

NPI: 1598477911
Provider Name (Legal Business Name): FANCY ROBOT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FOREST HOLLOW DR STE 200
ARGYLE TX
76226-9577
US

IV. Provider business mailing address

PO BOX 292251
LEWISVILLE TX
75029-2251
US

V. Phone/Fax

Practice location:
  • Phone: 972-951-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. NANCY J BLEDSOE-LINK
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 972-951-7000