=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356926661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KLARIEN MENTAL WELLNESS LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2021
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3795 ROY RICHARD DR STE 100
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-2893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-463-9199
-----------------------------------------------------
Fax | 210-783-1368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3795 ROY RICHARD DR STE 100
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-2893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-463-9199
-----------------------------------------------------
Fax | 210-783-1368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCESS MANAGER
-----------------------------------------------------
Name | KAREN DIXON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-461-8415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------