| Southern Area Behavioral Healthcare Llc | |
|
4215 Gannon Ln Dallas TX 75237-2914 | |
| (972) 283-9090 | |
| (972) 499-0367 |
| Full Name | Southern Area Behavioral Healthcare Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4215 Gannon Ln, Dallas, Texas |
| Authorized Official Name and Position | Kenneth R Medlock (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9722839090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Area Behavioral Healthcare Llc 4215 Gannon Ln Dallas TX 75237-2914 Ph: (972) 283-9090 | Southern Area Behavioral Healthcare Llc 4215 Gannon Ln Dallas TX 75237-2914 Ph: (972) 283-9090 |
| NPI Number | 1396973772 |
|---|---|
| Provider Enumeration Date | 06/24/2009 |
| Last Update Date | 01/03/2024 |
| Certification Date | 01/03/2024 |
| Medicare PECOS PAC ID | 1658699434 |
|---|---|
| Medicare Enrollment ID | O20150407000552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396973772 | NPI | - | NPPES |
| Provider Name | Florence K Choi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205266913 PECOS PAC ID: 7810124716 Enrollment ID: I20131223000829 |
| Provider Name | Sonya R Frank |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912485228 PECOS PAC ID: 4284984477 Enrollment ID: I20180910001779 |
| Provider Name | Kenneth Rogers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205844669 PECOS PAC ID: 2668375411 Enrollment ID: I20190116001167 |
| Provider Name | Devonn Dillard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740655406 PECOS PAC ID: 0749611192 Enrollment ID: I20200519001069 |
| Provider Name | Celia O Madu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932878519 PECOS PAC ID: 7911368089 Enrollment ID: I20230804003387 |
| Provider Name | Morgan M Medlock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952749954 PECOS PAC ID: 5092943019 Enrollment ID: I20230814002286 |
| Provider Name | David Kwame Dapaah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659640415 PECOS PAC ID: 1557718186 Enrollment ID: I20231103001076 |
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