MEDICARE: APN DFW MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164267316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APN DFW MENTAL HEALTH

Provider Business Mailing Address
First Line	:	2205 CORDILLERA WAY
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-6290
Country	:	US
Telephone Number	:	737-247-1223
Fax Number	:

Provider Business Practice Location Address
First Line	:	5637 N TARRANT PKWY STE D
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7321
Country	:	US
Telephone Number	:	682-708-0282
Fax Number	:

Authorized Official
Title or Position	:	REVENUE CYCLE ADMINISTRATOR
Name	:	ASHLEY BLAIR ELDER
Credential	:	PHD
Telephone Number	:	737-247-1223

Provider Enumeration Date	:	06/28/2024
Last Update Date	:	06/28/2024

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