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General NPI Number Information
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NPI Number | 1952958274
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS BRAIN AND WELLNESS, INC.
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 241 W. SOUTHLAKE BLVD., SUITE 140
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City | SOUTHLAKE
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State | TX
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Zip | 76092
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Country | US
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Telephone | 817-580-7678
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Fax | 817-580-7891
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Provider Business Mailing Address
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Address Line | PO BOX 470606
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City | FORT WORTH
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State | TX
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Zip | 76147-0606
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Country | US
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Telephone | 817-580-7678
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Fax | 817-580-7891
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA ASHLEY-ESCOTO
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Credential |
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Telephone | 817-580-7678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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