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General NPI Number Information
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NPI Number | 1740009596
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Entity Type | Organization
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Legal Business Name | BESPOKE WELLNESS
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 1010 E PARKERVILLE RD
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City | CEDAR HILL
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State | TX
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Zip | 75104-7100
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Country | US
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Telephone | 214-356-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 E PARKERVILLE RD
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City | CEDAR HILL
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State | TX
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Zip | 75104-7100
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Country | US
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Telephone | 214-356-2020
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KERENSA VERONICA BERRY-NERO
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Credential | MSW LCPA
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Telephone | 214-356-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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