Healthcare Provider Details

I. General information

NPI: 1154797801
Provider Name (Legal Business Name): FUSION FAMILY CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ALMA DR STE 480
PLANO TX
75075-6937
US

IV. Provider business mailing address

1700 ALMA DR STE 480
PLANO TX
75075-6937
US

V. Phone/Fax

Practice location:
  • Phone: 469-344-1414
  • Fax:
Mailing address:
  • Phone: 469-344-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberP5083
License Number StateTX

VIII. Authorized Official

Name: AMEENA ISA
Title or Position: PRINCIPAL
Credential: MD
Phone: 469-450-1457