Healthcare Provider Details

I. General information

NPI: 1629963855
Provider Name (Legal Business Name): MENTALITY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 TOWN PL # 26
FAIRVIEW TX
75069-1821
US

IV. Provider business mailing address

163 TOWN PL # 26
FAIRVIEW TX
75069-1821
US

V. Phone/Fax

Practice location:
  • Phone: 214-702-1840
  • Fax:
Mailing address:
  • Phone: 214-702-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KRYSTAL NICODEMUS
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 214-702-1840