| Southlake Neurology And | |
|
175 Stonebridge Ln Ste 100 Southlake TX 76092-0307 | |
| (817) 421-2905 | |
| (817) 431-6459 |
| Full Name | Southlake Neurology And |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 175 Stonebridge Ln Ste 100, Southlake, Texas |
| Authorized Official Name and Position | Asher S. Imam (PRESIDENT) |
| Authorized Official Contact | 8174212905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Neurology And 175 Stonebridge Ln Ste 100 Southlake TX 76092-0307 Ph: (817) 421-2905 | Southlake Neurology And 175 Stonebridge Ln Ste 100 Southlake TX 76092-0307 Ph: (817) 421-2905 |
| NPI Number | 1437362480 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 09/28/2020 |
| Certification Date | 09/28/2020 |
| Medicare PECOS PAC ID | 6507966108 |
|---|---|
| Medicare Enrollment ID | O20070711000954 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437362480 | NPI | - | NPPES |
| 10582985 | Other | CAQH ID | |
| K9573 | Other | TX | TEXAS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Asher S Imam |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1376602144 PECOS PAC ID: 0143320747 Enrollment ID: I20070712000259 |
| Provider Name | Lindsey Anne Cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538513973 PECOS PAC ID: 4082902051 Enrollment ID: I20170424001123 |
| Provider Name | Denise N Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225500168 PECOS PAC ID: 7012340334 Enrollment ID: I20191127000639 |
Pine Cone Therapies Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2104 Greenbriar Dr, Southlake, TX 76092 Phone: 817-442-9022 | |
Mindforge Psychiatry, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 950 E Highway 114, Suite 160, Southlake, TX 76092 Phone: 951-796-5464 | |
Pf Dover Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 515 W Southlake Blvd, Suite Number 172, Southlake, TX 76092 Phone: 309-363-2544 | |
Know Your Worth Counseling And Wellness Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1560 E Southlake Blvd Ste 100, Southlake, TX 76092 Phone: 817-668-0513 Fax: 817-662-7820 | |
Heritage Behavioral Health Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2485 E Southlake Blvd, Suite 180, Southlake, TX 76092 Phone: 817-488-9697 Fax: 817-488-9656 | |
Dana Lewin Counseling, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 420 N Carroll Ave Ste 140, Southlake, TX 76092 Phone: 817-797-7968 |