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5820 County Road 206 Grandview TX 76050-3229 | |
(469) 454-8727 | |
(469) 217-1245 |
Full Name | |
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Speciality | Counselor |
Location | 5820 County Road 206, Grandview, Texas |
Authorized Official Name and Position | Ashley Pillard (OWNER) |
Authorized Official Contact | 4694548727 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1309 Mansfield TX 76063-1309 Ph: (817) 307-1968 | 5820 County Road 206 Grandview TX 76050-3229 Ph: (469) 454-8727 |
NPI Number | 1396101382 |
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Provider Enumeration Date | 01/07/2016 |
Last Update Date | 06/21/2024 |
Certification Date | 06/21/2024 |
Medicare PECOS PAC ID | 0941643837 |
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Medicare Enrollment ID | O20240207003581 |
Identifier | Type | State | Issuer |
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1396101382 | NPI | - | NPPES |
362433001 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Ashley Pillard |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1700242799 PECOS PAC ID: 1850734740 Enrollment ID: I20240207003679 |