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General NPI Number Information
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NPI Number | 1477198109
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Entity Type | Organization
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Legal Business Name | PURA VIDA BEHAVIORAL WELLNESS, PLLC
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 325 N SAINT PAUL ST STE 3100
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City | DALLAS
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State | TX
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Zip | 75201-3923
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Country | US
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Telephone | 214-674-7859
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Fax |
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Provider Business Mailing Address
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Address Line | 325 N SAINT PAUL ST STE 3100
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City | DALLAS
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State | TX
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Zip | 75201-3923
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Country | US
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Telephone | 214-674-7859
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RITA T MCCALLAN
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Credential | PMHNP
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Telephone | 214-674-7859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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