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107 Woodbine Pl Longview TX 75601-2912 | |
| (903) 758-2471 | |
| (903) 234-1639 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 Woodbine Pl, Longview, Texas |
| Authorized Official Name and Position | Rosemary O Villarreal (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 9032344226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 6800 Longview TX 75608-6800 Ph: (903) 758-2471 | 107 Woodbine Pl Longview TX 75601-2912 Ph: (903) 758-2471 |
| NPI Number | 1639232002 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 06/14/2022 |
| Certification Date | 06/14/2022 |
| Medicare PECOS PAC ID | 0143202580 |
|---|---|
| Medicare Enrollment ID | O20040601001132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639232002 | NPI | - | NPPES |
| 00BM15 | Other | TX | BLUE CROSS BLUE SHIELD |
| 137921601 | Medicaid | TX | |
| 137921602 | Medicaid | TX | |
| 137921606 | Medicaid | TX | |
| 137921607 | Medicaid | TX | |
| 137921608 | Medicaid | TX | |
| 129201 | Other | TX | SUPERIOR HEALTH PLAN CHIP |
| CB6459 | Other | TX | RAILROAD MEDICARE |
| Provider Name | Gregory R Montoya |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083614176 PECOS PAC ID: 3173614765 Enrollment ID: I20070810000750 |
| Provider Name | Carrie D Hinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912914151 PECOS PAC ID: 6709956709 Enrollment ID: I20080603000345 |
| Provider Name | Dmitry V Listengarten |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669433173 PECOS PAC ID: 4486680931 Enrollment ID: I20100622000086 |
| Provider Name | Jeffrey G Mcwilliams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104037639 PECOS PAC ID: 9830242825 Enrollment ID: I20101004001231 |
| Provider Name | Rafael Ruiz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477578219 PECOS PAC ID: 7719043801 Enrollment ID: I20111110000899 |
| Provider Name | Brett Abernethy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134268436 PECOS PAC ID: 7810043973 Enrollment ID: I20130628000455 |
| Provider Name | Tho V Tran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104104207 PECOS PAC ID: 7012151186 Enrollment ID: I20130912000176 |
| Provider Name | Jawad Riaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962425280 PECOS PAC ID: 9335185446 Enrollment ID: I20131021001316 |
| Provider Name | Linesse Md Vega |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114105897 PECOS PAC ID: 6002047206 Enrollment ID: I20140402000550 |
| Provider Name | Shalunda R Sasser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710312285 PECOS PAC ID: 0244463396 Enrollment ID: I20140425001620 |
| Provider Name | Delisa Lynn Brooks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841625308 PECOS PAC ID: 2264661651 Enrollment ID: I20140520000542 |
| Provider Name | Khoa Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245674159 PECOS PAC ID: 3779784699 Enrollment ID: I20171205002080 |
| Provider Name | Elaina C Klimchuck |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326392721 PECOS PAC ID: 7517266422 Enrollment ID: I20190501000367 |
| Provider Name | Keith Allen Kirbow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376189308 PECOS PAC ID: 3072881200 Enrollment ID: I20200127001205 |
| Provider Name | Kimberly L Mabry-paroline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104460328 PECOS PAC ID: 4880029537 Enrollment ID: I20200127002031 |
| Provider Name | Deanna L Limburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063053239 PECOS PAC ID: 7517395536 Enrollment ID: I20200325000345 |
| Provider Name | Deanna E Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588293773 PECOS PAC ID: 9638509151 Enrollment ID: I20200424001861 |
| Provider Name | Deanna Robin Padgett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285148585 PECOS PAC ID: 1254696826 Enrollment ID: I20200914002576 |
| Provider Name | Jean Davi Pellegalle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013528884 PECOS PAC ID: 6204255938 Enrollment ID: I20200930001377 |
| Provider Name | Vikki H Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780239376 PECOS PAC ID: 3375962699 Enrollment ID: I20201006000420 |
| Provider Name | Wendy Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437749264 PECOS PAC ID: 3971919945 Enrollment ID: I20210317001818 |
| Provider Name | Jeremiah Brewer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679968697 PECOS PAC ID: 8426366378 Enrollment ID: I20210830002106 |
| Provider Name | Stephanie Sue White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093476798 PECOS PAC ID: 6800288903 Enrollment ID: I20220124000871 |
| Provider Name | Kelley Marie Thurston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477280014 PECOS PAC ID: 3971987306 Enrollment ID: I20220901002994 |
| Provider Name | Marina Natalya Randall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003594755 PECOS PAC ID: 5092162396 Enrollment ID: I20231108000969 |
| Provider Name | Charity Michal Anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043840291 PECOS PAC ID: 3678920857 Enrollment ID: I20231109001056 |
| Provider Name | Tia Gladden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932583440 PECOS PAC ID: 5890021679 Enrollment ID: I20231214000019 |
| Provider Name | Leah N Vernia-amend |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598109746 PECOS PAC ID: 5597115857 Enrollment ID: I20231228002175 |
| Provider Name | Amy Donahue |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396235057 PECOS PAC ID: 2961853676 Enrollment ID: I20240108000436 |
| Provider Name | Nicole Groves |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245941921 PECOS PAC ID: 0042661571 Enrollment ID: I20240109004680 |
| Provider Name | Kathryn Marie Stolle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235775917 PECOS PAC ID: 2062863400 Enrollment ID: I20240110000545 |
| Provider Name | Kory D Langley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225380413 PECOS PAC ID: 5496106866 Enrollment ID: I20240110001903 |
| Provider Name | Monica Reigh Bullock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972135655 PECOS PAC ID: 6901257146 Enrollment ID: I20240111003286 |
| Provider Name | Jessica M Cheshier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326521410 PECOS PAC ID: 4284086265 Enrollment ID: I20240115001844 |
| Provider Name | Michelle K Scott |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750762696 PECOS PAC ID: 1254783103 Enrollment ID: I20240117000930 |
| Provider Name | Shawn Walter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780137000 PECOS PAC ID: 6507218989 Enrollment ID: I20240122002680 |
| Provider Name | Kimberly Dawn Durham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952883480 PECOS PAC ID: 1759734551 Enrollment ID: I20240129001468 |
| Provider Name | Carol J Mccarthy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780445460 PECOS PAC ID: 6103279740 Enrollment ID: I20240130002748 |
| Provider Name | Kimberly D Reagan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356512495 PECOS PAC ID: 4082067426 Enrollment ID: I20240201001035 |
| Provider Name | Shequita L Daniels |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811636236 PECOS PAC ID: 2961855309 Enrollment ID: I20240201001140 |
| Provider Name | Marnie R Roozen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194021311 PECOS PAC ID: 2860835519 Enrollment ID: I20240209000169 |
| Provider Name | Rene Scherer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275764912 PECOS PAC ID: 8325481021 Enrollment ID: I20240209001610 |
| Provider Name | Roxanna Jean West |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497266175 PECOS PAC ID: 3375986078 Enrollment ID: I20240209001822 |
| Provider Name | Braden Ruth Friedrich |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073028049 PECOS PAC ID: 2264879204 Enrollment ID: I20240326001552 |
| Provider Name | Jennifer Wagner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508392135 PECOS PAC ID: 4587002761 Enrollment ID: I20240406000524 |
| Provider Name | Tammy Renee Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992406342 PECOS PAC ID: 3476995960 Enrollment ID: I20240529003793 |
| Provider Name | Sandy Janice Burton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205497120 PECOS PAC ID: 7113465642 Enrollment ID: I20240815002011 |
| Provider Name | Christopher Stephen Shelton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689403008 PECOS PAC ID: 0648718023 Enrollment ID: I20240815004652 |
| Provider Name | Oghenetega Mirella Meir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134965429 PECOS PAC ID: 2466991666 Enrollment ID: I20240903000837 |
| Provider Name | Rachel Ann Harrington |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568990372 PECOS PAC ID: 5991244097 Enrollment ID: I20240903000964 |
| Provider Name | Altreda Lanise Perkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023831815 PECOS PAC ID: 1052845054 Enrollment ID: I20241113003488 |
Heather R. Mcconnell, M.a., Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 911 W Loop 281, Suite 423, Longview, TX 75604 Phone: 903-759-2402 Fax: 903-759-2570 | |
Jonathan C. Lockhart, Md Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 911 W Loop 281, Suite 111, Longview, TX 75604 Phone: 903-295-8994 Fax: 903-295-8987 | |
Core Health Systems Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1300 N 6th St # A, Longview, TX 75601 Phone: 903-232-8928 Fax: 903-918-1813 | |
Willem H. Fahrenbruck, Lpc, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3122 Nealy Way Ste 201, Longview, TX 75605 Phone: 903-452-8040 | |
Diversified Psychological Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1508 W Fairmont St, Suite C, Longview, TX 75604 Phone: 903-238-9553 Fax: 903-291-8709 | |
7872 Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 615 Clinic Dr, Longview, TX 75605 Phone: 903-212-3105 |