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NPI Code Detail

MEDICARE: EVEREST FUNCTIONAL PSYCHIATRY AND WELLNESS, PLLC

MEDICARE: EVEREST FUNCTIONAL PSYCHIATRY AND 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
1251J00000XNursing Care Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11477211332OTHERNPI

General Provider Information

NPI Number : 1750080081
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVEREST FUNCTIONAL PSYCHIATRY AND WELLNESS, PLLC
Provider Business Mailing Address
First Line : 8222 DOUGLAS AVE STE 375
Second Line :
City : DALLAS
State : TX
Zip : 75225-5973
Country : US
Telephone Number : 972-839-8466
Fax Number :
Provider Business Practice Location Address
First Line : 8222 DOUGLAS AVE STE 375
Second Line :
City : DALLAS
State : TX
Zip : 75225-5973
Country : US
Telephone Number : 972-839-8466
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : EVEREST GOLDSTEIN
Credential :
Telephone Number : 972-839-8466
Provider Enumeration Date : 02/24/2023
Last Update Date : 02/24/2023

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Directions to “EVEREST FUNCTIONAL PSYCHIATRY AND WELLNESS, PLLC ” Practice Location

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