Healthcare Provider Details

I. General information

NPI: 1952859167
Provider Name (Legal Business Name): BETHESDA MENTAL HEALTH CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 05/31/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MCEWEN RD STE 410
DALLAS TX
75244-5217
US

IV. Provider business mailing address

4101 MCEWEN RD STE 410
DALLAS TX
75244-5217
US

V. Phone/Fax

Practice location:
  • Phone: 817-350-4377
  • Fax: 817-753-3216
Mailing address:
  • Phone: 817-350-4377
  • Fax: 817-753-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP124647
License Number StateTX

VIII. Authorized Official

Name: DIANNE MBAI
Title or Position: MANAGER
Credential: APRN, PMHNP-BC
Phone: 817-350-4377