MEDICARE: SALONE 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	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1649806001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALONE BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	1017 BURNET DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-2696
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 BURNET DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-2696
Country	:	US
Telephone Number	:	214-962-4537
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HASSANATU MICHAEL
Credential	:	DNP
Telephone Number	:	214-962-4537

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/18/2020

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