Provider Demographics
NPI:1093349581
Name:TEXARKANA MENTAL HEALTH AND WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:TEXARKANA MENTAL HEALTH AND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSION COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:903-824-2624
Mailing Address - Street 1:4140 MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0921
Mailing Address - Country:US
Mailing Address - Phone:903-824-2624
Mailing Address - Fax:
Practice Address - Street 1:4140 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0921
Practice Address - Country:US
Practice Address - Phone:903-824-2624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty