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General NPI Number Information
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NPI Number | 1760338727
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Entity Type | Organization
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Legal Business Name | EMMANUEL BEHAVIORAL HEALTH & WELLNESS PLLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 1328 HERITAGE BLVD # 5
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City | LONGVIEW
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State | TX
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Zip | 75605-1472
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Country | US
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Telephone | 903-260-0412
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 HERITAGE BLVD 0FFICE # 5
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City | LONGVIEW
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State | TX
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Zip | 75605-1472
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Country | US
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Telephone | 903-260-0412
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | LATONYA POLK
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Credential | PMHNP-BC
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Telephone | 903-315-8302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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