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General NPI Number Information
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NPI Number | 1699581082
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Entity Type | Organization
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Legal Business Name | SOUTHWEST AGAPE WELLNESS, PLLC
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 4103 WILBARGER ST
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City | VERNON
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State | TX
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Zip | 76384-3137
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Country | US
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Telephone | 940-655-8291
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Fax |
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Provider Business Mailing Address
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Address Line | 4103 WILBARGER ST
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City | VERNON
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State | TX
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Zip | 76384-3137
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Country | US
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Telephone | 940-655-8291
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Fax | 940-304-8197
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Authorized Official
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Title or Position | MANAGING MEMBER / OWNER
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Name | GUSTAVO ALCANTAR ALEMAN JR.
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Credential | PMHNP-BC
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Telephone | 940-655-8291
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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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