Healthcare Provider Details

I. General information

NPI: 1528490687
Provider Name (Legal Business Name): CHASTITY V ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 DARK FOREST DR
MCKINNEY TX
75070-6998
US

IV. Provider business mailing address

5912 DARK FOREST DR
MCKINNEY TX
75070-6998
US

V. Phone/Fax

Practice location:
  • Phone: 214-934-5164
  • Fax:
Mailing address:
  • Phone: 214-934-5164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: