Provider Demographics
NPI:1326731464
Name:DALLAS MENTAL HEALTH AND PERFORMANCE, PLLC
Entity Type:Organization
Organization Name:DALLAS MENTAL HEALTH AND PERFORMANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:469-900-7536
Mailing Address - Street 1:12801 N CENTRAL EXPY STE 1560
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1886
Mailing Address - Country:US
Mailing Address - Phone:469-900-7536
Mailing Address - Fax:
Practice Address - Street 1:12801 N CENTRAL EXPY STE 1560
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1886
Practice Address - Country:US
Practice Address - Phone:469-900-7536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty