Provider Demographics
NPI:1467081398
Name:PSY-CLARITY MENTAL HEALTH
Entity Type:Organization
Organization Name:PSY-CLARITY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:318-272-8386
Mailing Address - Street 1:647 DELORES DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4850
Mailing Address - Country:US
Mailing Address - Phone:318-272-8386
Mailing Address - Fax:
Practice Address - Street 1:647 DELORES DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4850
Practice Address - Country:US
Practice Address - Phone:318-272-8386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty