Healthcare Provider Details

I. General information

NPI: 1437950318
Provider Name (Legal Business Name): JERRELL ALRICO ESCOTT-COLLINS QMHP-CS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 US HIGHWAY 80 E STE 223
MESQUITE TX
75150-3353
US

IV. Provider business mailing address

3939 US HIGHWAY 80 E STE 223
MESQUITE TX
75150-3353
US

V. Phone/Fax

Practice location:
  • Phone: 254-216-4072
  • Fax:
Mailing address:
  • Phone: 254-216-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: