| Mind Body Wellness Pc | |
|
17304 Preston Rd Ste 800 Dallas TX 75252-5645 | |
| (972) 849-8987 | |
| Not Available |
| Full Name | Mind Body Wellness Pc |
|---|---|
| Speciality | Psychologist |
| Location | 17304 Preston Rd Ste 800, Dallas, Texas |
| Authorized Official Name and Position | Kristi Roper (PARTNER) |
| Authorized Official Contact | 2147631985 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Wellness Pc Po Box 934068 Margate FL 33093-4068 Ph: (954) 366-2700 | Mind Body Wellness Pc 17304 Preston Rd Ste 800 Dallas TX 75252-5645 Ph: (972) 849-8987 |
| NPI Number | 1710929450 |
|---|---|
| Provider Enumeration Date | 06/10/2006 |
| Last Update Date | 02/22/2021 |
| Certification Date | 02/04/2021 |
| Medicare PECOS PAC ID | 6800879438 |
|---|---|
| Medicare Enrollment ID | O20040612000347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710929450 | NPI | - | NPPES |
| 178166801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| Provider Name | Kristi D Roper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508807207 PECOS PAC ID: 2466435029 Enrollment ID: I20040612000710 |
| Provider Name | Patrick Andrew Clifford |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467495416 PECOS PAC ID: 8729061387 Enrollment ID: I20040614000181 |
| Provider Name | Holly Anne Lawrence |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760436638 PECOS PAC ID: 2264446392 Enrollment ID: I20060127000626 |
| Provider Name | M Eileen Beiler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801832308 PECOS PAC ID: 2163524364 Enrollment ID: I20070219000276 |
| Provider Name | Dayle Cathleen Lattie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508035353 PECOS PAC ID: 5698851657 Enrollment ID: I20130925000633 |
| Provider Name | Tricia Favre |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073789459 PECOS PAC ID: 3274766829 Enrollment ID: I20140506000310 |
| Provider Name | Christie Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831500222 PECOS PAC ID: 3577788868 Enrollment ID: I20140630000640 |
| Provider Name | Julie Dimock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225427974 PECOS PAC ID: 6305161878 Enrollment ID: I20150205000465 |
| Provider Name | Jamile A Ashmore |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740297506 PECOS PAC ID: 5395881858 Enrollment ID: I20201104002886 |
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