Healthcare Provider Details

I. General information

NPI: 1134937980
Provider Name (Legal Business Name): HLTX2 PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CRESCENT CT STE 700
DALLAS TX
75201-2112
US

IV. Provider business mailing address

100 CRESCENT CT STE 700
DALLAS TX
75201-2112
US

V. Phone/Fax

Practice location:
  • Phone: 310-892-4284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE GENEN
Title or Position: CEO
Credential: MD
Phone: 310-892-4284