| Pine Cone Therapies Llc | |
|
2104 Greenbriar Dr Southlake TX 76092-8355 | |
| (817) 442-9022 | |
| Not Available |
| Full Name | Pine Cone Therapies Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2104 Greenbriar Dr, Southlake, Texas |
| Authorized Official Name and Position | Bobbye R Records (OWNER) |
| Authorized Official Contact | 8174429022 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Cone Therapies Llc 2104 Greenbriar Dr Southlake TX 76092-8355 Ph: (817) 442-9022 | Pine Cone Therapies Llc 2104 Greenbriar Dr Southlake TX 76092-8355 Ph: (817) 442-9022 |
| NPI Number | 1013143767 |
|---|---|
| Provider Enumeration Date | 06/09/2009 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 6002967098 |
|---|---|
| Medicare Enrollment ID | O20090702000507 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013143767 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-10-7860 (Texas) | Primary |
| Provider Name | Bobbye R Records |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1710102298 PECOS PAC ID: 9931250925 Enrollment ID: I20090702000497 |
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