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3417 Gaston Ave Ste 815 Dallas TX 75246-2034 | |
| (214) 520-7575 | |
| (214) 520-7579 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3417 Gaston Ave Ste 815, Dallas, Texas |
| Authorized Official Name and Position | Barry Jay Fenton (PHYSICIAN) |
| Authorized Official Contact | 2145207575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3417 Gaston Ave Ste 815 Dallas TX 75246-2034 Ph: (214) 520-7575 | 3417 Gaston Ave Ste 815 Dallas TX 75246-2034 Ph: (214) 520-7575 |
| NPI Number | 1912032319 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 01/21/2025 |
| Certification Date | 01/21/2025 |
| Medicare PECOS PAC ID | 8022072602 |
|---|---|
| Medicare Enrollment ID | O20041113000179 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912032319 | NPI | - | NPPES |
| Provider Name | Barry J Fenton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417082892 PECOS PAC ID: 6103880786 Enrollment ID: I20120912000806 |
| Provider Name | Karen Sue Kelley |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1134254493 PECOS PAC ID: 2860838927 Enrollment ID: I20240312000013 |
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