Healthcare Provider Details

I. General information

NPI: 1023740503
Provider Name (Legal Business Name): ESSENTIAL MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N SAINT PAUL ST STE 3100
DALLAS TX
75201-3923
US

IV. Provider business mailing address

325 N SAINT PAUL ST STE 3100
DALLAS TX
75201-3923
US

V. Phone/Fax

Practice location:
  • Phone: 917-667-2201
  • Fax:
Mailing address:
  • Phone: 917-667-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS AIDA DABREO
Title or Position: CEO
Credential: NP
Phone: 917-667-2201