Healthcare Provider Details

I. General information

NPI: 1720830805
Provider Name (Legal Business Name): INSTITUTE FOR RELATIONAL WELL-BEING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 08/05/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 FARM TO MARKET ROAD 407
ARGYLE TX
76226
US

IV. Provider business mailing address

1621 LA PLAYA AVE APT 24
SAN DIEGO CA
92109-6473
US

V. Phone/Fax

Practice location:
  • Phone: 619-320-8213
  • Fax:
Mailing address:
  • Phone: 619-320-8213
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. VERONICA PATRICIA VIESCA
Title or Position: OWNER, EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 619-746-0669