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General NPI Number Information
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NPI Number | 1194287896
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Entity Type | Organization
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Legal Business Name | OPTASIA BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 406 S CHESTNUT ST
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City | MCKINNEY
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State | TX
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Zip | 75069-5610
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Country | US
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Telephone | 469-396-4314
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Fax |
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Provider Business Mailing Address
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Address Line | 3918 POPLAR POINT DR
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City | ROCKWALL
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State | TX
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Zip | 75032-9275
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Country | US
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Telephone |
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Fax | 469-533-8848
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Authorized Official
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Title or Position | CO-OWNER
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Name | KIMBERLEE FLATT
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Credential | PHD, LPC, BCBA-LBA
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Telephone | 469-396-4314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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