MEDICARE: BSW GEODE CLINICIANS OF TEXAS 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1790482834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BSW GEODE CLINICIANS OF TEXAS PLLC

Provider Business Mailing Address
First Line	:	1211 W 22ND ST STE 406
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-2169
Country	:	US
Telephone Number	:	630-912-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 S WATTERS RD STE 130
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-5008
Country	:	US
Telephone Number	:	469-854-3263
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BRANDY MARRINER
Credential	:
Telephone Number	:	630-912-4241

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	02/02/2026

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