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General NPI Number Information
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NPI Number | 1427619964
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Entity Type | Organization
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Legal Business Name | NEUROTHERAPEUTIC
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 4144 N CENTRAL EXPY STE 600
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City | DALLAS
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State | TX
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Zip | 75204-3131
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Country | US
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Telephone | 214-461-9483
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Fax |
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Provider Business Mailing Address
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Address Line | 8135 FOREST LN # 51523
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City | DALLAS
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State | TX
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Zip | 75230-2472
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | REBECCA WALKER
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Credential |
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Telephone | 318-932-1463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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