| Bluebonnet Trails Community Services | |
|
1009 N Georgetown St Round Rock TX 78664-3289 | |
| (512) 255-1720 | |
| (512) 244-8371 |
| Full Name | Bluebonnet Trails Community Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 1009 N Georgetown St, Round Rock, Texas |
| Authorized Official Name and Position | Amy Bodkins (MANAGER) |
| Authorized Official Contact | 5122448374 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluebonnet Trails Community Services 1009 N Georgetown St Round Rock TX 78664-3289 Ph: (512) 255-1720 | Bluebonnet Trails Community Services 1009 N Georgetown St Round Rock TX 78664-3289 Ph: (512) 255-1720 |
| NPI Number | 1730135864 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 08/28/2023 |
| Certification Date | 08/28/2023 |
| Medicare PECOS PAC ID | 5799775409 |
|---|---|
| Medicare Enrollment ID | O20040514000751 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730135864 | NPI | - | NPPES |
| 1268443 03 | Medicaid | TX | |
| 0797201 01 | Medicaid | TX | |
| 1268443 02 | Medicaid | TX | |
| 1268443 05 | Medicaid | TX | |
| 1268443 04 | Medicaid | TX | |
| 1268443 01 | Medicaid | TX |
| Provider Name | Carol A Nati |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326091075 PECOS PAC ID: 8426957465 Enrollment ID: I20040108000166 |
| Provider Name | John M Janes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497813224 PECOS PAC ID: 4880688126 Enrollment ID: I20040412000280 |
| Provider Name | Arif M Shoaib |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407838394 PECOS PAC ID: 1850374695 Enrollment ID: I20040611000394 |
| Provider Name | Janice E Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447287925 PECOS PAC ID: 4082698477 Enrollment ID: I20040614001730 |
| Provider Name | Michael A Shiekh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386863397 PECOS PAC ID: 8729062146 Enrollment ID: I20040615000223 |
| Provider Name | Sharadamani Anandan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750490991 PECOS PAC ID: 0446236129 Enrollment ID: I20040624001112 |
| Provider Name | Robert C Strayhan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023178043 PECOS PAC ID: 7810980828 Enrollment ID: I20040817000043 |
| Provider Name | Murali Veeramachaneni |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851374367 PECOS PAC ID: 8729041777 Enrollment ID: I20041110000497 |
| Provider Name | Leslie A Lindholm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821014630 PECOS PAC ID: 6507819687 Enrollment ID: I20050301000584 |
| Provider Name | Kerri Ann Halfant |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043248099 PECOS PAC ID: 0143269597 Enrollment ID: I20050426000928 |
| Provider Name | Maitreyee P Lund |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285677559 PECOS PAC ID: 6800827031 Enrollment ID: I20050826000396 |
| Provider Name | Florence F Eddins Folensbee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700966041 PECOS PAC ID: 5890727754 Enrollment ID: I20050831000702 |
| Provider Name | Gregory Paul |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053324095 PECOS PAC ID: 8426089970 Enrollment ID: I20060113000495 |
| Provider Name | Pamela J Petersen-crair |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023127271 PECOS PAC ID: 8820004278 Enrollment ID: I20060222000831 |
| Provider Name | Carlos F. Tirado |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255388203 PECOS PAC ID: 7113920406 Enrollment ID: I20060804000177 |
| Provider Name | Michael A Fuller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922054725 PECOS PAC ID: 8921004516 Enrollment ID: I20061004000256 |
| Provider Name | Susan D Nash |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619025186 PECOS PAC ID: 9739271545 Enrollment ID: I20070824000460 |
| Provider Name | Andrew H Martin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356434146 PECOS PAC ID: 7810083177 Enrollment ID: I20071017000759 |
| Provider Name | Laurel Blackman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194752576 PECOS PAC ID: 5294816773 Enrollment ID: I20080123000152 |
| Provider Name | Patricia S Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922292036 PECOS PAC ID: 3870675762 Enrollment ID: I20080131000140 |
| Provider Name | Tracie M Dejarnette Holly |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699786681 PECOS PAC ID: 5890790109 Enrollment ID: I20080227000401 |
| Provider Name | Clinton Price |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720169253 PECOS PAC ID: 9537127626 Enrollment ID: I20080303000090 |
| Provider Name | David E O Connor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699798595 PECOS PAC ID: 1456240472 Enrollment ID: I20080327000360 |
| Provider Name | Avrim Brett Fishkind |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093727943 PECOS PAC ID: 2466539804 Enrollment ID: I20080409000300 |
| Provider Name | Melissa Nylander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568520575 PECOS PAC ID: 5496826430 Enrollment ID: I20080618000329 |
| Provider Name | Kevin J Simmons |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255479887 PECOS PAC ID: 0941374789 Enrollment ID: I20080728000806 |
| Provider Name | Arlene M Zwald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023128980 PECOS PAC ID: 5597762807 Enrollment ID: I20081121000606 |
| Provider Name | Preeti Sodhi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033268065 PECOS PAC ID: 7113089152 Enrollment ID: I20081229000377 |
| Provider Name | Wren A Deavers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356392682 PECOS PAC ID: 2860545944 Enrollment ID: I20090807000003 |
| Provider Name | Keith William Caramelli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538211941 PECOS PAC ID: 6204973886 Enrollment ID: I20091030000409 |
| Provider Name | Robin E Hostetter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003972829 PECOS PAC ID: 1355499260 Enrollment ID: I20091130000070 |
| Provider Name | Cheryl L Pullium |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1871643270 PECOS PAC ID: 1759422355 Enrollment ID: I20100105000199 |
| Provider Name | Gurjeet S Shokar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467520957 PECOS PAC ID: 9931234127 Enrollment ID: I20100312000527 |
| Provider Name | Renda J Holladay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235321696 PECOS PAC ID: 4486782893 Enrollment ID: I20100505000732 |
| Provider Name | Holly Colleen Dubois |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518086511 PECOS PAC ID: 4880773092 Enrollment ID: I20100513001132 |
| Provider Name | Lisamar Maldonado |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316127467 PECOS PAC ID: 2163555970 Enrollment ID: I20100730000539 |
| Provider Name | Amanda R Rizzari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881894707 PECOS PAC ID: 1557553500 Enrollment ID: I20101008000236 |
| Provider Name | Ranelle Sutton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144435496 PECOS PAC ID: 0840483723 Enrollment ID: I20101023000230 |
| Provider Name | Courtney Bearden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992015572 PECOS PAC ID: 7719160050 Enrollment ID: I20110324000594 |
| Provider Name | Stephen Dai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629271432 PECOS PAC ID: 0244416964 Enrollment ID: I20110513000655 |
| Provider Name | Lili Meisamy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386894277 PECOS PAC ID: 0446436182 Enrollment ID: I20110516000153 |
| Provider Name | Ziba Rezaee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902066236 PECOS PAC ID: 5092983908 Enrollment ID: I20110720000553 |
| Provider Name | Shauna S Reid |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396949533 PECOS PAC ID: 8628241817 Enrollment ID: I20111103000602 |
| Provider Name | Cynthia G Weston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952523540 PECOS PAC ID: 5193990141 Enrollment ID: I20111202000584 |
| Provider Name | Cendy S Brister-antley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144517558 PECOS PAC ID: 0749455319 Enrollment ID: I20111209000110 |
| Provider Name | Prakash S Shet |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285606327 PECOS PAC ID: 0648172312 Enrollment ID: I20120314000810 |
| Provider Name | Abila F Awan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952486979 PECOS PAC ID: 8224130638 Enrollment ID: I20120612000265 |
| Provider Name | Christopher Chee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447480173 PECOS PAC ID: 9537325329 Enrollment ID: I20120723000914 |
| Provider Name | Sarah A Fry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659650935 PECOS PAC ID: 3870759350 Enrollment ID: I20120727000508 |
| Provider Name | Justin James Parrott |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053677179 PECOS PAC ID: 5597921924 Enrollment ID: I20120730000285 |
| Provider Name | Deena Velazquez Dong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114281243 PECOS PAC ID: 2163678772 Enrollment ID: I20120815000230 |
| Provider Name | Patricia H Vanwinkle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861778755 PECOS PAC ID: 4587811229 Enrollment ID: I20120830000769 |
| Provider Name | Roger G Joe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578755070 PECOS PAC ID: 6103090683 Enrollment ID: I20121001000431 |
| Provider Name | Anna M Francis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609127026 PECOS PAC ID: 1456501196 Enrollment ID: I20121015000735 |
| Provider Name | Matthew Michael Williams |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962545491 PECOS PAC ID: 6507016458 Enrollment ID: I20121030000493 |
| Provider Name | Johnes B Monyoncho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427301597 PECOS PAC ID: 4587815048 Enrollment ID: I20121108000620 |
| Provider Name | Cesar De Paz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568620672 PECOS PAC ID: 1254570294 Enrollment ID: I20130624000034 |
| Provider Name | Lyle B Montgomery |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730208158 PECOS PAC ID: 7315855491 Enrollment ID: I20130709000231 |
| Provider Name | Darice M Rodriguez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043479892 PECOS PAC ID: 0042453607 Enrollment ID: I20130829000271 |
| Provider Name | Kellye N Singletary |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063433324 PECOS PAC ID: 5698918480 Enrollment ID: I20130829000722 |
| Provider Name | Anastasia Corker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558701565 PECOS PAC ID: 8921241225 Enrollment ID: I20130906000138 |
| Provider Name | Laura V Settlage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750726345 PECOS PAC ID: 5496999534 Enrollment ID: I20130911000688 |
| Provider Name | Marjorie E Lieser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639510894 PECOS PAC ID: 6103060447 Enrollment ID: I20130926000353 |
| Provider Name | Jawad Riaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962425280 PECOS PAC ID: 9335185446 Enrollment ID: I20131021001316 |
| Provider Name | Shameem Shaik |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134230840 PECOS PAC ID: 0143455386 Enrollment ID: I20131024001199 |
| Provider Name | Mark Schuchman |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1467517300 PECOS PAC ID: 2961683487 Enrollment ID: I20131104001245 |
| Provider Name | Rabab Rizvi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326269382 PECOS PAC ID: 6002042165 Enrollment ID: I20131119001280 |
| Provider Name | Naim A Memon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972605152 PECOS PAC ID: 8628058823 Enrollment ID: I20131213000013 |
| Provider Name | Seema S Varghees |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568625044 PECOS PAC ID: 5193953313 Enrollment ID: I20140116000155 |
| Provider Name | Marikje O Shreeve |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134450067 PECOS PAC ID: 4587793815 Enrollment ID: I20140205000454 |
| Provider Name | Elizabeth Hill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255547055 PECOS PAC ID: 2961593496 Enrollment ID: I20140228001225 |
| Provider Name | Linesse Md Vega |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114105897 PECOS PAC ID: 6002047206 Enrollment ID: I20140402000550 |
| Provider Name | Claydeen Harrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275958225 PECOS PAC ID: 3779715677 Enrollment ID: I20140408000956 |
| Provider Name | Yan Cao |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033443700 PECOS PAC ID: 9830232263 Enrollment ID: I20140513001481 |
| Provider Name | Daniel F Shreeve |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760597082 PECOS PAC ID: 9739156589 Enrollment ID: I20140519000126 |
| Provider Name | Rohini Ravindran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508091265 PECOS PAC ID: 4688899834 Enrollment ID: I20140702001883 |
| Provider Name | Victor G Stiebel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164423364 PECOS PAC ID: 7719889278 Enrollment ID: I20140811000605 |
| Provider Name | Donovan A Wong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437315967 PECOS PAC ID: 4082752688 Enrollment ID: I20140904002674 |
| Provider Name | Gollavelli Krishna |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871754036 PECOS PAC ID: 5092779223 Enrollment ID: I20141018000097 |
| Provider Name | Namita G Shiralkar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053569897 PECOS PAC ID: 4385866599 Enrollment ID: I20141103002240 |
| Provider Name | Lacey Np Lundgren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689088205 PECOS PAC ID: 8426270596 Enrollment ID: I20141105002608 |
| Provider Name | Erica N Buch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891102570 PECOS PAC ID: 0143442046 Enrollment ID: I20141110000435 |
| Provider Name | Michele Wang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942473442 PECOS PAC ID: 7012181183 Enrollment ID: I20141111000893 |
| Provider Name | Deana G Abdel-reheim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467696591 PECOS PAC ID: 7315169984 Enrollment ID: I20141114001510 |
| Provider Name | Frieda Aboul-fotouh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437394293 PECOS PAC ID: 5799950564 Enrollment ID: I20141215001438 |
| Provider Name | Theresa Diem-hang Bui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144576414 PECOS PAC ID: 7214253962 Enrollment ID: I20150224001338 |
| Provider Name | Silby J George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518362623 PECOS PAC ID: 5294053914 Enrollment ID: I20150409000662 |
| Provider Name | Shiny Abraham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740456144 PECOS PAC ID: 8527218841 Enrollment ID: I20150422001948 |
| Provider Name | Shaheena Minhas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750461141 PECOS PAC ID: 7911147723 Enrollment ID: I20150424002062 |
| Provider Name | Shalanda R Cross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174963821 PECOS PAC ID: 9335468222 Enrollment ID: I20150427000999 |
| Provider Name | Meredith L Tompkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104258169 PECOS PAC ID: 3173843471 Enrollment ID: I20150528001770 |
| Provider Name | Kathy Rivera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174636203 PECOS PAC ID: 0345240248 Enrollment ID: I20150603002570 |
| Provider Name | Aaron J Alaniz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851684039 PECOS PAC ID: 0547573354 Enrollment ID: I20150723007146 |
| Provider Name | Natalia Kazakevich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447570999 PECOS PAC ID: 6608180542 Enrollment ID: I20150805008027 |
| Provider Name | Stephanie V Hernandez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215297221 PECOS PAC ID: 0042526683 Enrollment ID: I20150827002465 |
| Provider Name | Heath B Foreman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871819755 PECOS PAC ID: 6709192883 Enrollment ID: I20150903002532 |
| Provider Name | Robert M Katz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558658534 PECOS PAC ID: 7517107568 Enrollment ID: I20150918002105 |
| Provider Name | Ashutosh Atri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215294004 PECOS PAC ID: 2668638693 Enrollment ID: I20150929002661 |
| Provider Name | Ronald St Hill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316032147 PECOS PAC ID: 0648201822 Enrollment ID: I20151001001342 |
| Provider Name | John D Walsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790169738 PECOS PAC ID: 7810206620 Enrollment ID: I20151019000741 |
| Provider Name | Odochi P Onungwa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811373673 PECOS PAC ID: 4183790678 Enrollment ID: I20151125000322 |
| Provider Name | John Kenny |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750449732 PECOS PAC ID: 9739102716 Enrollment ID: I20151217000691 |
| Provider Name | Steffani L Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881870244 PECOS PAC ID: 7719051499 Enrollment ID: I20151230000584 |
| Provider Name | Sandra Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891166161 PECOS PAC ID: 5395047328 Enrollment ID: I20160108000334 |
| Provider Name | Anandkumar B Panchal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629453303 PECOS PAC ID: 7810291408 Enrollment ID: I20160202000337 |
| Provider Name | Rachel Masters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952766222 PECOS PAC ID: 4385949502 Enrollment ID: I20160226000386 |
| Provider Name | Nicolas D Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023243995 PECOS PAC ID: 9032387576 Enrollment ID: I20160330001073 |
| Provider Name | Karyn Lee Flores |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1861619157 PECOS PAC ID: 8426087917 Enrollment ID: I20160414000299 |
| Provider Name | Flavio Casoy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992032908 PECOS PAC ID: 7214106657 Enrollment ID: I20160427000281 |
| Provider Name | Neha P Chaudhary |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720346315 PECOS PAC ID: 1850685280 Enrollment ID: I20160809000206 |
| Provider Name | Felix A Geller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902073216 PECOS PAC ID: 2163672684 Enrollment ID: I20160811002590 |
| Provider Name | Erika June Canales |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508226705 PECOS PAC ID: 2769777176 Enrollment ID: I20160824002325 |
| Provider Name | Deepak Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548403827 PECOS PAC ID: 7911022959 Enrollment ID: I20161025002615 |
| Provider Name | Christine Kessel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710430624 PECOS PAC ID: 8022396662 Enrollment ID: I20161102000051 |
| Provider Name | Sandra Yaklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073068870 PECOS PAC ID: 6608155965 Enrollment ID: I20161109002629 |
| Provider Name | Kathleen Pixley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316490220 PECOS PAC ID: 6709166051 Enrollment ID: I20161205000178 |
| Provider Name | Biren P Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932543311 PECOS PAC ID: 8729368477 Enrollment ID: I20161215000175 |
| Provider Name | Gina K In |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861759672 PECOS PAC ID: 1658652938 Enrollment ID: I20161228000795 |
| Provider Name | Rene Melendez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215139597 PECOS PAC ID: 0547294159 Enrollment ID: I20170126000721 |
| Provider Name | Katherine A Tharp |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558743070 PECOS PAC ID: 2466732565 Enrollment ID: I20170223001905 |
| Provider Name | Necole L Rivers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053468603 PECOS PAC ID: 5294019626 Enrollment ID: I20170303001064 |
| Provider Name | Micah J Knobles |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144668831 PECOS PAC ID: 4789951310 Enrollment ID: I20170601001464 |
| Provider Name | Jessica C Reuben |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083974992 PECOS PAC ID: 9537441654 Enrollment ID: I20170717001292 |
| Provider Name | Michelle F Grasso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902338536 PECOS PAC ID: 9032489034 Enrollment ID: I20170725000853 |
| Provider Name | David Gavito |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255777215 PECOS PAC ID: 0840579371 Enrollment ID: I20170816003139 |
| Provider Name | Alicia A Vasquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861915266 PECOS PAC ID: 0941573588 Enrollment ID: I20170905000037 |
| Provider Name | Joshua D Lord |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255751376 PECOS PAC ID: 4486928439 Enrollment ID: I20170914002939 |
| Provider Name | Elizabeth Samuels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558885582 PECOS PAC ID: 6709150329 Enrollment ID: I20170920004142 |
| Provider Name | Lindsey F Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881117208 PECOS PAC ID: 0042584591 Enrollment ID: I20170921001529 |
| Provider Name | Susan Carpenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649796665 PECOS PAC ID: 9830465772 Enrollment ID: I20171020002764 |
| Provider Name | Marguerite M Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891186789 PECOS PAC ID: 7719244797 Enrollment ID: I20171129001710 |
| Provider Name | Amelia Cobb |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1508016858 PECOS PAC ID: 2466719984 Enrollment ID: I20171207002342 |
| Provider Name | Arjun G Karkhanis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336465806 PECOS PAC ID: 9638476575 Enrollment ID: I20171208000083 |
| Provider Name | Susan Zink |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174843510 PECOS PAC ID: 5092993824 Enrollment ID: I20180117001120 |
| Provider Name | Sandra Neli Diaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730539602 PECOS PAC ID: 2466732219 Enrollment ID: I20180208000469 |
| Provider Name | Samuel D Scott |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831584069 PECOS PAC ID: 9931461134 Enrollment ID: I20180328002205 |
| Provider Name | Jennifer C Schaefer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750782215 PECOS PAC ID: 0941508139 Enrollment ID: I20180702001323 |
| Provider Name | Danielle A Cleveland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891272050 PECOS PAC ID: 6507115524 Enrollment ID: I20180823001534 |
| Provider Name | Monika N Adamaszek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255817896 PECOS PAC ID: 7416208293 Enrollment ID: I20180918000703 |
| Provider Name | Sarah Hite |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093296287 PECOS PAC ID: 8921350174 Enrollment ID: I20181016002851 |
| Provider Name | Christina S Williams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396159679 PECOS PAC ID: 0648523282 Enrollment ID: I20181029000500 |
| Provider Name | Yvonne M Burke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407807233 PECOS PAC ID: 7719990662 Enrollment ID: I20181115002636 |
| Provider Name | Anna I Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346715273 PECOS PAC ID: 4385998756 Enrollment ID: I20181121001999 |
| Provider Name | Daniel R Lavin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750676532 PECOS PAC ID: 3072883859 Enrollment ID: I20181207000870 |
| Provider Name | Ryan Landis Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750760948 PECOS PAC ID: 6103131495 Enrollment ID: I20190117002183 |
| Provider Name | Zachary Robert Drennan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841728011 PECOS PAC ID: 8325317076 Enrollment ID: I20190123000520 |
| Provider Name | Jamon Blood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316333552 PECOS PAC ID: 8426341926 Enrollment ID: I20190130001747 |
| Provider Name | Jordan Kristyne Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912401464 PECOS PAC ID: 8426396243 Enrollment ID: I20190220001646 |
| Provider Name | Elizabeth Diaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326517111 PECOS PAC ID: 4082953682 Enrollment ID: I20190226001520 |
| Provider Name | Nargis N Ali |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083974943 PECOS PAC ID: 8527308402 Enrollment ID: I20190313001426 |
| Provider Name | Jack L Housworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225319379 PECOS PAC ID: 8022358522 Enrollment ID: I20190320000903 |
| Provider Name | Joel Garrett Massey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396805966 PECOS PAC ID: 7618115130 Enrollment ID: I20190329000883 |
| Provider Name | Kari Whatley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033505979 PECOS PAC ID: 3375853856 Enrollment ID: I20190404001661 |
| Provider Name | Kellie R Wylie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295293942 PECOS PAC ID: 8729320874 Enrollment ID: I20190422001236 |
| Provider Name | Beth K Boyarsky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487731758 PECOS PAC ID: 6305936352 Enrollment ID: I20190514000669 |
| Provider Name | Lilian N Yamoah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902460157 PECOS PAC ID: 3375879810 Enrollment ID: I20190722003320 |
| Provider Name | Nicholas F Ortiz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164878914 PECOS PAC ID: 8628305612 Enrollment ID: I20190814001400 |
| Provider Name | Lakeisha Yvette Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144651399 PECOS PAC ID: 0446587208 Enrollment ID: I20190816001111 |
| Provider Name | Kelly A Campbell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205240611 PECOS PAC ID: 9739478595 Enrollment ID: I20190828002958 |
| Provider Name | Amanda Marie Moreno |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104203637 PECOS PAC ID: 2264761105 Enrollment ID: I20190903000729 |
| Provider Name | Shadi Lavasani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366891665 PECOS PAC ID: 7416238399 Enrollment ID: I20191203002552 |
| Provider Name | Aina Oyibo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548626435 PECOS PAC ID: 0648181750 Enrollment ID: I20191205002649 |
| Provider Name | Hayley Kimble |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043708753 PECOS PAC ID: 7517390164 Enrollment ID: I20191212000716 |
| Provider Name | Janessa Daniels |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699314856 PECOS PAC ID: 6204263676 Enrollment ID: I20200225000046 |
| Provider Name | Freya Spielberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467664607 PECOS PAC ID: 9537248836 Enrollment ID: I20200228001143 |
| Provider Name | Vanitha D Kothapalli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164788709 PECOS PAC ID: 2062716681 Enrollment ID: I20200402000682 |
| Provider Name | Grace H Kang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528563574 PECOS PAC ID: 2365799723 Enrollment ID: I20200403001665 |
| Provider Name | Jasmin Jaimes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255967881 PECOS PAC ID: 3072942598 Enrollment ID: I20200406000087 |
| Provider Name | Gloria Osuozah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376844738 PECOS PAC ID: 0345670766 Enrollment ID: I20200424001986 |
| Provider Name | Stacen J Velvin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285124743 PECOS PAC ID: 8729335120 Enrollment ID: I20200601000022 |
| Provider Name | Matthew R Sorenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619361474 PECOS PAC ID: 2163843962 Enrollment ID: I20200603001850 |
| Provider Name | Brian V Clinton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811481898 PECOS PAC ID: 2365799798 Enrollment ID: I20200812002785 |
| Provider Name | Scott J Tlanda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720440431 PECOS PAC ID: 6507283793 Enrollment ID: I20200902002186 |
| Provider Name | Azuka D Udolisa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730486077 PECOS PAC ID: 6608159876 Enrollment ID: I20201001001850 |
| Provider Name | Doris Poston |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1275059479 PECOS PAC ID: 0143631739 Enrollment ID: I20201203001379 |
| Provider Name | Victoria Ambrus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215260161 PECOS PAC ID: 0547672214 Enrollment ID: I20201222001863 |
| Provider Name | Morgan Ballantine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598343212 PECOS PAC ID: 9537577846 Enrollment ID: I20210426000498 |
| Provider Name | Sharon Bloom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902473168 PECOS PAC ID: 3375946031 Enrollment ID: I20210720000291 |
| Provider Name | Maria Fatherree |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255004164 PECOS PAC ID: 4688079585 Enrollment ID: I20210816001468 |
| Provider Name | Lisa Church |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598222309 PECOS PAC ID: 3072919570 Enrollment ID: I20210909000160 |
| Provider Name | Alba Lara |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073047767 PECOS PAC ID: 2961800743 Enrollment ID: I20211008000299 |
| Provider Name | Frances Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720567936 PECOS PAC ID: 7315345006 Enrollment ID: I20211011002056 |
| Provider Name | Rebecca Montgomery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184234262 PECOS PAC ID: 7214325505 Enrollment ID: I20211019000335 |
| Provider Name | Diem Huong Pham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679014914 PECOS PAC ID: 6608264403 Enrollment ID: I20211028000180 |
| Provider Name | Jennifer Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114464898 PECOS PAC ID: 8123410321 Enrollment ID: I20220120001713 |
| Provider Name | Omagbitse Jagha |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164181970 PECOS PAC ID: 5597157404 Enrollment ID: I20220126000347 |
| Provider Name | Michael Watkins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932761640 PECOS PAC ID: 6901132620 Enrollment ID: I20220308002515 |
| Provider Name | Lori Kumar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083365076 PECOS PAC ID: 1153716980 Enrollment ID: I20220315000518 |
| Provider Name | Amanda Mendez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427706886 PECOS PAC ID: 7113313107 Enrollment ID: I20220330002272 |
| Provider Name | Andrew Wong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558867465 PECOS PAC ID: 6709132459 Enrollment ID: I20220428000667 |
| Provider Name | Colette Helene Kendrick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073074019 PECOS PAC ID: 0749669190 Enrollment ID: I20220615002394 |
| Provider Name | Cassandra Boduch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083177497 PECOS PAC ID: 2163803487 Enrollment ID: I20220719000165 |
| Provider Name | Eneida F Miranda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598293284 PECOS PAC ID: 6305266123 Enrollment ID: I20220815002830 |
| Provider Name | Kyle M Hodges |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134756455 PECOS PAC ID: 4880015650 Enrollment ID: I20220831000479 |
| Provider Name | Van Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194214429 PECOS PAC ID: 0749664258 Enrollment ID: I20220901001924 |
| Provider Name | Jonathan D Artz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841828506 PECOS PAC ID: 5890126445 Enrollment ID: I20221007001150 |
| Provider Name | Marisela Munoz Puga |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710515994 PECOS PAC ID: 8325415540 Enrollment ID: I20221101001599 |
| Provider Name | John J Byun |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932763620 PECOS PAC ID: 5991035883 Enrollment ID: I20221107000363 |
| Provider Name | Sheila Moore-bunch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275765083 PECOS PAC ID: 9133253396 Enrollment ID: I20230223002043 |
| Provider Name | Diane Brandmiller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447295043 PECOS PAC ID: 7416953484 Enrollment ID: I20230224000144 |
| Provider Name | Loy Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689803496 PECOS PAC ID: 9133555816 Enrollment ID: I20230307003234 |
| Provider Name | Martika Channel Jones |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629757299 PECOS PAC ID: 9537522461 Enrollment ID: I20230825000586 |
| Provider Name | Brooke Ryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861171803 PECOS PAC ID: 8123481819 Enrollment ID: I20230829000839 |
| Provider Name | Nicholas Kreyling |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538738497 PECOS PAC ID: 9436551900 Enrollment ID: I20231009001378 |
| Provider Name | Ashley Philpo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871215616 PECOS PAC ID: 2062868169 Enrollment ID: I20231026000014 |
| Provider Name | Jonathan Lee Hulkower |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063597961 PECOS PAC ID: 0749323343 Enrollment ID: I20231130000581 |
| Provider Name | Mareth Carlberg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093390445 PECOS PAC ID: 3072961069 Enrollment ID: I20231201001018 |
| Provider Name | Brenda Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497280879 PECOS PAC ID: 5496103327 Enrollment ID: I20231202000071 |
| Provider Name | Rhonda Barnard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972201440 PECOS PAC ID: 9335597285 Enrollment ID: I20231203000049 |
| Provider Name | Audrea Herrera |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427797174 PECOS PAC ID: 7911356738 Enrollment ID: I20231205003213 |
| Provider Name | Hannah Corcoran |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497009088 PECOS PAC ID: 8426407263 Enrollment ID: I20231206000174 |
| Provider Name | Laura Wolf |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639664618 PECOS PAC ID: 3173972932 Enrollment ID: I20231206000889 |
| Provider Name | Rick Treadway-teran |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1326067810 PECOS PAC ID: 0345699120 Enrollment ID: I20231206001427 |
| Provider Name | Laura Nutt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972932473 PECOS PAC ID: 1456700145 Enrollment ID: I20231206002280 |
| Provider Name | Ashley Davis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710639067 PECOS PAC ID: 6709235401 Enrollment ID: I20231206002763 |
| Provider Name | Herbert Goldsmith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578899605 PECOS PAC ID: 4587013289 Enrollment ID: I20231206002936 |
| Provider Name | Kyle Mccall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063013985 PECOS PAC ID: 0941659619 Enrollment ID: I20231207001525 |
| Provider Name | Jonathan Canava |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881115350 PECOS PAC ID: 0446609085 Enrollment ID: I20231208000417 |
| Provider Name | Lauren Bryant |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235711144 PECOS PAC ID: 7113376690 Enrollment ID: I20231208002261 |
| Provider Name | Heidi Riemer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932643574 PECOS PAC ID: 9335598473 Enrollment ID: I20231214000430 |
| Provider Name | Carl Crowther |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275569626 PECOS PAC ID: 1850740721 Enrollment ID: I20231218002788 |
| Provider Name | Savannah Howe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487254611 PECOS PAC ID: 1759731540 Enrollment ID: I20231219004088 |
| Provider Name | Kristin York |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295120830 PECOS PAC ID: 6204286040 Enrollment ID: I20231220001561 |
| Provider Name | Megan Yale |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831518737 PECOS PAC ID: 6608226444 Enrollment ID: I20231220001807 |
| Provider Name | Tressie Keilman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497523724 PECOS PAC ID: 0840641536 Enrollment ID: I20240106000967 |
| Provider Name | Jennifer Broussard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689164436 PECOS PAC ID: 3577914035 Enrollment ID: I20240109002296 |
| Provider Name | Wendy Key |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164950093 PECOS PAC ID: 6608227905 Enrollment ID: I20240111001335 |
| Provider Name | Jeffrey Evans |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457899973 PECOS PAC ID: 8921459108 Enrollment ID: I20240111004863 |
| Provider Name | Brianna Quarles |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891573705 PECOS PAC ID: 9638521537 Enrollment ID: I20240116003626 |
| Provider Name | Mollie Robins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316026750 PECOS PAC ID: 6608228341 Enrollment ID: I20240118002683 |
| Provider Name | Dorothy Long |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689293235 PECOS PAC ID: 6800248303 Enrollment ID: I20240120000121 |
| Provider Name | Gary Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942490222 PECOS PAC ID: 8921450123 Enrollment ID: I20240123002556 |
| Provider Name | Julie Joffray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942747829 PECOS PAC ID: 4880047943 Enrollment ID: I20240125001802 |
| Provider Name | Brittney Broadway |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851034037 PECOS PAC ID: 6709239379 Enrollment ID: I20240130003693 |
| Provider Name | Daniel Ascencao |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659540458 PECOS PAC ID: 2668815887 Enrollment ID: I20240205002764 |
| Provider Name | Kenneth Collins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386672566 PECOS PAC ID: 4981047008 Enrollment ID: I20240206002133 |
| Provider Name | Karen Schwing |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376300863 PECOS PAC ID: 9537507397 Enrollment ID: I20240329002137 |
Infinite Potential Counseling, Inc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1000 Gattis School Rd Ste 410, Round Rock, TX 78664 Phone: 512-230-3740 | |
Community Health And Wellness Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Chisholm Trail Rd Ste 450, Round Rock, TX 78681 Phone: 512-961-5316 | |
Life In Motion Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1311 Chisholm Trl, Ste 301, Round Rock, TX 78681 Phone: 512-799-4875 | |
Counseling Forward, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 620 Rusk Rd, Round Rock, TX 78665 Phone: 832-523-3700 Fax: 737-205-6966 | |
Elevate Metal Health Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3001 Joe Dimaggio Blvd Ste 900b, Round Rock, TX 78665 Phone: 512-729-1800 | |
Brooke D. Peplinski, Lpc, Ncc, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 600 Round Rock West Drive #305, Round Rock, TX 78681 Phone: 262-853-7752 | |
Redesigning Lives, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1200 Hidden Valley Dr Apt 1521, Round Rock, TX 78665 Phone: 225-590-5051 Fax: 833-967-1840 |