| Freedom Behavioral Health Texas Pllc | |
|
6601 Montana Ave Ste J El Paso TX 79925-2143 | |
| (915) 234-6227 | |
| (877) 839-4682 |
| Full Name | Freedom Behavioral Health Texas Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6601 Montana Ave Ste J, El Paso, Texas |
| Authorized Official Name and Position | Kerry Clemetson (DIRECTOR OF BILLING/CREDENTIALING) |
| Authorized Official Contact | 9134757713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Freedom Behavioral Health Texas Pllc 6601 Montana Ave Ste J El Paso TX 79925-2143 Ph: (915) 234-6227 | Freedom Behavioral Health Texas Pllc 6601 Montana Ave Ste J El Paso TX 79925-2143 Ph: (915) 234-6227 |
| NPI Number | 1568227015 |
|---|---|
| Provider Enumeration Date | 02/14/2024 |
| Last Update Date | 05/20/2024 |
| Certification Date | 05/20/2024 |
| Medicare PECOS PAC ID | 9133569189 |
|---|---|
| Medicare Enrollment ID | O20240424003463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568227015 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Alynna A Manriquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093056947 PECOS PAC ID: 7719127984 Enrollment ID: I20130711000379 |
| Provider Name | Krystal Lane Speier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891071684 PECOS PAC ID: 0345689063 Enrollment ID: I20240424003834 |
| Provider Name | David Wichman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760695290 PECOS PAC ID: 2062585805 Enrollment ID: I20240424003909 |
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