Healthcare Provider Details

I. General information

NPI: 1902414402
Provider Name (Legal Business Name): SUNRISE TOTAL MIND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 RIVER ACRES DR
NEW BRAUNFELS TX
78130-3689
US

IV. Provider business mailing address

1672 INDEPENDENCE DR STE 310
NEW BRAUNFELS TX
78132-3982
US

V. Phone/Fax

Practice location:
  • Phone: 830-730-4194
  • Fax: 830-302-2092
Mailing address:
  • Phone: 830-730-5025
  • Fax: 830-730-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: VERONICA HARLAN
Title or Position: CREDENTIALING MANGER
Credential:
Phone: 830-730-5025