Healthcare Provider Details

I. General information

NPI: 1194605006
Provider Name (Legal Business Name): MARIANA KEJAIRWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18601 LYNDON B JOHNSON FWY STE 711
MESQUITE TX
75150-6436
US

IV. Provider business mailing address

5353 LAS COLINAS BLVD APT 2406
IRVING TX
75039-4464
US

V. Phone/Fax

Practice location:
  • Phone: 469-260-2063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99469
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: