Healthcare Provider Details

I. General information

NPI: 1467265496
Provider Name (Legal Business Name): INTROSPECTIVE WELLNESS MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8056 COLBI LN
FORT WORTH TX
76120-5633
US

IV. Provider business mailing address

PO BOX 24331
FORT WORTH TX
76124-1331
US

V. Phone/Fax

Practice location:
  • Phone: 817-658-0438
  • Fax:
Mailing address:
  • Phone: 817-658-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RAHMEKA PATRICK
Title or Position: DIRECTOR
Credential: LPC
Phone: 817-658-0438