MEDICARE: MOLINA PSYCHIATRIC ASSOCIATES PA

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	:	1831756303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLINA PSYCHIATRIC ASSOCIATES PA

Provider Business Mailing Address
First Line	:	17300 DALLAS PKWY STE 1006
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1145
Country	:	US
Telephone Number	:	817-873-0595
Fax Number	:	817-873-0596

Provider Business Practice Location Address
First Line	:	17300 DALLAS PKWY STE 1006
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1145
Country	:	US
Telephone Number	:	817-873-0595
Fax Number	:	817-873-0596

Authorized Official
Title or Position	:	MANAGED CARE COORDINATOR
Name	:	SHAUN RICHARDSON
Credential	:
Telephone Number	:	817-873-0595

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	05/07/2026

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