Provider Demographics
NPI:1558763086
Name:ADOLESCENT AND YOUNG ADULT HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ADOLESCENT AND YOUNG ADULT HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN-REMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-733-6565
Mailing Address - Street 1:16980 DALLAS PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1910
Mailing Address - Country:US
Mailing Address - Phone:972-733-6565
Mailing Address - Fax:972-733-6564
Practice Address - Street 1:16980 DALLAS PKWY STE 204
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1910
Practice Address - Country:US
Practice Address - Phone:972-733-6565
Practice Address - Fax:972-733-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty