Provider Demographics
NPI:1174861983
Name:BASEPOINT PSYCHIATRY AND WELLNESS
Entity Type:Organization
Organization Name:BASEPOINT PSYCHIATRY AND WELLNESS
Other - Org Name:CHANGEPOINT COUNSELING SERVICES, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-793-0636
Mailing Address - Street 1:713 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9147
Mailing Address - Country:US
Mailing Address - Phone:972-325-2584
Mailing Address - Fax:972-552-5499
Practice Address - Street 1:713 W BROAD ST
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9147
Practice Address - Country:US
Practice Address - Phone:972-552-5559
Practice Address - Fax:972-552-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30000382Medicaid