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120 River Oaks Dr Ste 140 Southlake TX 76092-6882 | |
| (817) 778-8884 | |
| (817) 385-6540 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 120 River Oaks Dr Ste 140, Southlake, Texas |
| Authorized Official Name and Position | Vishal Pankajkumar Shah (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8177788884 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
120 River Oaks Dr Ste 140 Southlake TX 76092-6882 Ph: (817) 778-8884 | 120 River Oaks Dr Ste 140 Southlake TX 76092-6882 Ph: (817) 778-8884 |
| NPI Number | 1649788373 |
|---|---|
| Provider Enumeration Date | 01/16/2018 |
| Last Update Date | 01/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649788373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | Q5097 (Texas) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | Q5097 (Texas) | Primary |
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