| Redefine Llc | |
|
620 Stoneglen Dr Ste B Keller TX 76248-3625 | |
| (817) 562-8800 | |
| (817) 562-8829 |
| Full Name | Redefine Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 620 Stoneglen Dr Ste B, Keller, Texas |
| Authorized Official Name and Position | Diana Bigham (OWNER) |
| Authorized Official Contact | 8175628800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Redefine Llc 620 Stoneglen Dr Ste B Keller TX 76248-3625 Ph: (817) 562-8800 | Redefine Llc 620 Stoneglen Dr Ste B Keller TX 76248-3625 Ph: (817) 562-8800 |
| NPI Number | 1134773997 |
|---|---|
| Provider Enumeration Date | 07/30/2019 |
| Last Update Date | 07/30/2019 |
| Medicare PECOS PAC ID | 4284071879 |
|---|---|
| Medicare Enrollment ID | O20240319000557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134773997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Thomas Walter Hudson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528747813 PECOS PAC ID: 3678910270 Enrollment ID: I20240319000800 |
| Provider Name | Darlene Tate |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811181829 PECOS PAC ID: 6800233412 Enrollment ID: I20240319001001 |
| Provider Name | Kimberly Jill Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023890811 PECOS PAC ID: 7517304132 Enrollment ID: I20240319001353 |
| Provider Name | Crystal G Thompson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548017148 PECOS PAC ID: 9032550512 Enrollment ID: I20240515001262 |
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