MEDICARE: SOLIDBASE BEHAVIORAL HEALTH PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1275311888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLIDBASE BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	6060 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5209
Country	:	US
Telephone Number	:	945-296-2799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 SHACKELFORD LN
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-5096
Country	:	US
Telephone Number	:	945-296-2799
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	EZIAHA IHEDIWAH
Credential	:
Telephone Number	:	945-296-2799

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	05/20/2026

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