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12609 Blue Ridge Dr Frisco TX 75033-0970 | |
| (469) 685-3572 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 12609 Blue Ridge Dr, Frisco, Texas |
| Authorized Official Name and Position | Mary Elizabeth Roldan-balboa (OWNER) |
| Authorized Official Contact | 4696853572 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12609 Blue Ridge Dr Frisco TX 75033-0970 Ph: (469) 685-3572 | 12609 Blue Ridge Dr Frisco TX 75033-0970 Ph: (469) 685-3572 |
| NPI Number | 1639633233 |
|---|---|
| Provider Enumeration Date | 01/28/2019 |
| Last Update Date | 11/20/2024 |
| Certification Date | 11/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639633233 | NPI | - | NPPES |
| 1376084046 | Other | TX | MEDICIAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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