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General NPI Number Information
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NPI Number | 1124347026
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Entity Type | Organization
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Legal Business Name | NEUROWELLNESS
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 5310 HARVEST HILL RD SUITE 165
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City | DALLAS
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State | TX
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Zip | 75230-5806
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Country | US
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Telephone | 972-386-9776
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Fax | 972-365-3171
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Provider Business Mailing Address
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Address Line | 5310 HARVEST HILL RD SUITE 165
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City | DALLAS
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State | TX
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Zip | 75230-5806
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Country | US
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Telephone | 972-386-9776
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Fax | 972-365-3171
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Authorized Official
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Title or Position | PRESIDENT, DIR OF CLINICAL SERVICES
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Name | DR. ROSS M STEWART
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Credential | PH.D
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Telephone | 972-386-9776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 7388
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 437
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01124
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | MFC 7388 437
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License Number State | TX
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