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General NPI Number Information
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NPI Number | 1467265496
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Entity Type | Organization
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Legal Business Name | INTROSPECTIVE WELLNESS MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 8056 COLBI LN
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City | FORT WORTH
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State | TX
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Zip | 76120-5633
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Country | US
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Telephone | 817-658-0438
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24331
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City | FORT WORTH
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State | TX
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Zip | 76124-1331
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Country | US
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Telephone | 817-658-0438
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RAHMEKA PATRICK
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Credential | LPC
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Telephone | 817-658-0438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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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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