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2750 W. Virginia Pkwy Ste 108 Mckinney TX 75071 | |
| (972) 542-8144 | |
| (972) 548-9891 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 2750 W. Virginia Pkwy, Mckinney, Texas |
| Authorized Official Name and Position | Kelli Smart (OFFICE MANAGER) |
| Authorized Official Contact | 9725428144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2750 W. Virginia Parkway Ste 108 Mckinney TX 75071 Ph: (972) 542-8144 | 2750 W. Virginia Pkwy Ste 108 Mckinney TX 75071 Ph: (972) 542-8144 |
| NPI Number | 1629156682 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 09/19/2022 |
| Certification Date | 09/19/2022 |
| Medicare PECOS PAC ID | 9931585619 |
|---|---|
| Medicare Enrollment ID | O20221004000505 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629156682 | NPI | - | NPPES |
| 289748 | Other | VALUE OPTIONS | |
| 0060GD | Other | TX | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Jamaica Reyes-araujo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407067382 PECOS PAC ID: 6002990322 Enrollment ID: I20080226000391 |
| Provider Name | Charukesi Chandrasekaran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508173170 PECOS PAC ID: 1153630090 Enrollment ID: I20151016000293 |
| Provider Name | Deborah F Oyegoke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578015491 PECOS PAC ID: 4284666306 Enrollment ID: I20161114000127 |
| Provider Name | Rob Hall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679167688 PECOS PAC ID: 6800239906 Enrollment ID: I20240206001323 |
| Provider Name | Jeffrey David Mcmanus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558955369 PECOS PAC ID: 8022553098 Enrollment ID: I20240715000884 |
| Provider Name | Messay Tula Oshe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205582293 PECOS PAC ID: 2769921063 Enrollment ID: I20240830001288 |
| Provider Name | Jill Marie Lueke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972218774 PECOS PAC ID: 4688109655 Enrollment ID: I20241127002581 |
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