=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508017658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN ELLEN PRESCOTT RN, PMHCNS-BC, LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2008
-----------------------------------------------------
Last Update Date | 01/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 S LANCASTER RD MENTAL HEALTH (116A)
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75216-7167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-857-1004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2804 AMHERST AVE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-226-5489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 598523
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------