Provider Demographics
NPI:1114966074
Name:H. E. B. BEHAVIORAL MEDICINE, P. C.
Entity Type:Organization
Organization Name:H. E. B. BEHAVIORAL MEDICINE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, H. E. B. BEHAVIORAL MEDI
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:TURNBULL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-571-2899
Mailing Address - Street 1:12701 BEECH TREE LN
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3427
Mailing Address - Country:US
Mailing Address - Phone:682-553-8027
Mailing Address - Fax:817-571-9879
Practice Address - Street 1:305 MIRON DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7831
Practice Address - Country:US
Practice Address - Phone:817-571-2899
Practice Address - Fax:817-571-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352891OtherMHN
TX37LJOtherMAGELLAN HMO BLUE
TX10011985OtherAMERIGROUP CLAIMS
TX2155975OtherCIGNA BEHAVIORAL HEALTH
TX195435OtherAMERIGROUP
TX224689OtherTEXAS REHAB COMMISSION
TX00478YOtherMEDICARE PTAN
TX489437OtherVALUE OPTIONS
TX0417750-04OtherTEXAS STAR
TX86960AOtherBLUE CROSS BLUE SHIELD
TX37LJOtherMAGELLAN HMO BLUE
TX46039513176040OtherTRICARE