MEDICARE: PRESTON HOLLOW HEALTH & WELLNESS, 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	103TC0700X	Clinical Psychologist	37647	TX
2	103TC1900X	Counseling Psychologist	36341	TX
3	103T00000X	Psychologist	36341	TX

General Provider Information

NPI Number	:	1487183406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTON HOLLOW HEALTH & WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	8140 WALNUT HILL LN STE 320
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4328
Country	:	US
Telephone Number	:	972-773-9027
Fax Number	:	972-474-9043

Provider Business Practice Location Address
First Line	:	8140 WALNUT HILL LN STE 320
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4328
Country	:	US
Telephone Number	:	972-773-9027
Fax Number	:	972-474-9043

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER W. BRADFORD
Credential	:	PHD
Telephone Number	:	972-863-2232

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	10/03/2023

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