Managing Life Mental Health Clinic Llc | |
1708 Dayton Ave Wichita Falls TX 76301-6110 | |
(940) 500-4408 | |
(940) 386-1318 |
Full Name | Managing Life Mental Health Clinic Llc |
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Speciality | Counselor |
Location | 1708 Dayton Ave, Wichita Falls, Texas |
Authorized Official Name and Position | Diane Sheree Eakins (OWNER) |
Authorized Official Contact | 9405004408 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Managing Life Mental Health Clinic Llc 4860 Rhea Road Wichita Falls TX 76308-4404 Ph: (940) 276-2400 | Managing Life Mental Health Clinic Llc 1708 Dayton Ave Wichita Falls TX 76301-6110 Ph: (940) 500-4408 |
NPI Number | 1932706512 |
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Provider Enumeration Date | 10/06/2020 |
Last Update Date | 04/28/2021 |
Certification Date | 04/28/2021 |
Medicare PECOS PAC ID | 9436560638 |
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Medicare Enrollment ID | O20201119000358 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932706512 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
Provider Name | Thomas J Cleary |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1952300162 PECOS PAC ID: 2466525407 Enrollment ID: I20080723000733 |
Provider Name | Diane Sheree Eakins |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841765872 PECOS PAC ID: 1254752090 Enrollment ID: I20200602002047 |
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