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270 N Denton Tap Rd Ste 160 Coppell TX 75019-2133 | |
| (972) 304-0700 | |
| (972) 692-5844 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 270 N Denton Tap Rd Ste 160, Coppell, Texas |
| Authorized Official Name and Position | Audrey Ellen Kteily (OWNER) |
| Authorized Official Contact | 9723040700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
270 N Denton Tap Rd Ste 160 Coppell TX 75019-2133 Ph: (972) 304-0700 | 270 N Denton Tap Rd Ste 160 Coppell TX 75019-2133 Ph: (972) 304-0700 |
| NPI Number | 1801421938 |
|---|---|
| Provider Enumeration Date | 03/09/2020 |
| Last Update Date | 09/23/2021 |
| Certification Date | 09/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801421938 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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