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General NPI Number Information
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NPI Number | 1104445220
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Entity Type | Organization
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Legal Business Name | NEOGEN MENTAL HEALTH AND BEHAVIORAL SERVICES, PA.
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 2141 KIRKWOOD BLVD STE 130
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1464
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Country | US
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Telephone | 469-955-5223
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Fax | 817-251-8844
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Provider Business Mailing Address
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Address Line | 2141 KIRKWOOD BLVD STE 130
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1464
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Country | US
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Telephone | 469-955-5223
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Fax | 817-251-8844
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. EUGENE H FLETCHER
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Credential | DO
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Telephone | 469-955-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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