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175 S Ridge Rd Ste 200 Mckinney TX 75072-5104 | |
| (469) 833-2247 | |
| (469) 914-9249 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 175 S Ridge Rd Ste 200, Mckinney, Texas |
| Authorized Official Name and Position | Lewis Copeland (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4698332247 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3511 Springbell St Celina TX 75009-0852 Ph: (785) 534-9004 | 175 S Ridge Rd Ste 200 Mckinney TX 75072-5104 Ph: (469) 833-2247 |
| NPI Number | 1942914445 |
|---|---|
| Provider Enumeration Date | 01/09/2023 |
| Last Update Date | 07/30/2024 |
| Certification Date | 07/27/2024 |
| Medicare PECOS PAC ID | 8426596115 |
|---|---|
| Medicare Enrollment ID | O20240813001352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942914445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Charmaine Desiree Solomon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801063706 PECOS PAC ID: 1052551140 Enrollment ID: I20240813001504 |
| Provider Name | Lewis Allen Copeland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811429962 PECOS PAC ID: 1153869847 Enrollment ID: I20240813003040 |
| Provider Name | Calen Shirlece Hawkins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871274779 PECOS PAC ID: 9133667793 Enrollment ID: I20240814000055 |
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