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1835 E Southlake Blvd Ste 100 Southlake TX 76092-7068 | |
| (817) 769-7687 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1835 E Southlake Blvd Ste 100, Southlake, Texas |
| Authorized Official Name and Position | Allyson Stuckless (OWNER) |
| Authorized Official Contact | 8179154622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1835 E Southlake Blvd Ste 100 Southlake TX 76092-7068 Ph: (817) 769-7687 | 1835 E Southlake Blvd Ste 100 Southlake TX 76092-7068 Ph: (817) 769-7687 |
| NPI Number | 1164160099 |
|---|---|
| Provider Enumeration Date | 05/20/2022 |
| Last Update Date | 08/22/2024 |
| Certification Date | 08/22/2024 |
| Medicare PECOS PAC ID | 8527509835 |
|---|---|
| Medicare Enrollment ID | O20240925004697 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164160099 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Allyson Levon Stuckless |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184247314 PECOS PAC ID: 9436690740 Enrollment ID: I20240925004711 |
| Provider Name | Heather Laura O'flaherty |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912551789 PECOS PAC ID: 1355882622 Enrollment ID: I20240926002098 |
| Provider Name | Lillian Kaye Wendt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679269211 PECOS PAC ID: 6608317979 Enrollment ID: I20240926002203 |
| Provider Name | Lonni Paige Alderman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366099400 PECOS PAC ID: 0941741227 Enrollment ID: I20240926002340 |
| Provider Name | Mia Chikita Burgan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386377067 PECOS PAC ID: 4284175563 Enrollment ID: I20240926002464 |
| Provider Name | Neha Asif |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1003485814 PECOS PAC ID: 8325589617 Enrollment ID: I20240926002707 |
| Provider Name | Rachel Marie Judd |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659126332 PECOS PAC ID: 1355872649 Enrollment ID: I20240926003027 |
| Provider Name | Sheresa Michelle Dagley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124742747 PECOS PAC ID: 5890228845 Enrollment ID: I20241029002270 |
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