Back Porch Therapy Pllc | |
1800 Shiloh Rd Ste 101 Tyler TX 75703-2456 | |
(903) 515-1474 | |
Not Available |
Full Name | Back Porch Therapy Pllc |
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Speciality | Clinic/Center |
Location | 1800 Shiloh Rd Ste 101, Tyler, Texas |
Authorized Official Name and Position | Jocelyn Sipes (THERAPIST) |
Authorized Official Contact | 9035151474 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Back Porch Therapy Pllc 1800 Shiloh Rd Ste 101 Tyler TX 75703-2456 Ph: (903) 515-1474 | Back Porch Therapy Pllc 1800 Shiloh Rd Ste 101 Tyler TX 75703-2456 Ph: (903) 515-1474 |
NPI Number | 1730730052 |
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Provider Enumeration Date | 09/27/2019 |
Last Update Date | 09/27/2019 |
Medicare PECOS PAC ID | 4486078664 |
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Medicare Enrollment ID | O20200721002424 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730730052 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
Provider Name | Jocelyn C Sipes |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1407348030 PECOS PAC ID: 8022432202 Enrollment ID: I20200721002739 |
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