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General NPI Number Information
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NPI Number | 1851714166
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Entity Type | Organization
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Legal Business Name | GENUINE LIFE WELLNESS PLLC
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 8340 MEADOW RD STE 224
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City | DALLAS
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State | TX
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Zip | 75231-0326
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Country | US
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Telephone | 972-742-2186
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Fax | 469-232-9943
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Provider Business Mailing Address
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Address Line | 8340 MEADOW RD STE 224
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City | DALLAS
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State | TX
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Zip | 75231-0326
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Country | US
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Telephone | 972-742-2186
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Fax | 469-232-9943
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Authorized Official
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Title or Position | SINGLE MEMBER, LICENSED PSYCHOLOGIS
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Name | DR. JENNIFER S HARTMAN
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Credential | PH.D.
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Telephone | 972-742-2186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32123
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License Number State | TX
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