Healthcare Provider Details

I. General information

NPI: 1831671296
Provider Name (Legal Business Name): POSITIVE PERCEPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 09/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 RAY WHITE RD STE 200
FORT WORTH TX
76244-9105
US

IV. Provider business mailing address

2350 RAVENWOOD DR
GRAND PRAIRIE TX
75050-2027
US

V. Phone/Fax

Practice location:
  • Phone: 214-228-3916
  • Fax: 855-529-3367
Mailing address:
  • Phone: 817-691-3343
  • Fax: 855-529-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number00141022
License Number StateNJ
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20126
License Number StateTX

VIII. Authorized Official

Name: JEANETTE ANN WEEMS
Title or Position: DIRECTOR
Credential: LPC-S, CCM, CRC
Phone: 214-228-3916