=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821755182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATHOPE PSYCHIATRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2021
-----------------------------------------------------
Last Update Date | 02/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 E INTERSTATE 30 STE B106
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75043-4047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-778-0263
-----------------------------------------------------
Fax | 469-778-0262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 E INTERSTATE 30 STE B106
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75043-4047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-778-0263
-----------------------------------------------------
Fax | 469-778-0262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE/BILLING MANAGER
-----------------------------------------------------
Name | MRS. JENNIPHER MANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-778-0263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------