=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942016258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORK-IN THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2024
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 GATEWAY BLVD STE 219
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-522-2346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8213 MEADOW RD APT 1136
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-522-2346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICIAN/OWNER
-----------------------------------------------------
Name | DELENNY DUBOSE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 615-522-2346
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------