Provider Demographics
NPI:1477198109
Name:PURA VIDA BEHAVIORAL WELLNESS, PLLC
Entity Type:Organization
Organization Name:PURA VIDA BEHAVIORAL WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:214-674-7859
Mailing Address - Street 1:325 N SAINT PAUL ST STE 3100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3923
Mailing Address - Country:US
Mailing Address - Phone:214-674-7859
Mailing Address - Fax:
Practice Address - Street 1:325 N SAINT PAUL ST STE 3100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3923
Practice Address - Country:US
Practice Address - Phone:214-674-7859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty