=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881842102
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSY-MED, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2008
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8140 WALNUT HILL LANE SUITE 308
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-348-5557
-----------------------------------------------------
Fax | 214-348-5898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8140 WALNUT HILL LANE SUITE 308
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-348-5557
-----------------------------------------------------
Fax | 214-348-5898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DWAYNE ANTHONY GUCCIONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-348-5557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133VN1201X
-----------------------------------------------------
Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TH0004X
-----------------------------------------------------
Taxonomy Name | Health Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------