Provider Demographics
NPI:1568146637
Name:FRESH START WITH YOUR STORY, PLLC
Entity Type:Organization
Organization Name:FRESH START WITH YOUR STORY, PLLC
Other - Org Name:ELLIE MENTAL HEALTH PLANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BHAVIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:469-828-6385
Mailing Address - Street 1:5700 W PLANO PKWY STE 3600
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2455
Mailing Address - Country:US
Mailing Address - Phone:830-357-8933
Mailing Address - Fax:
Practice Address - Street 1:5700 W PLANO PKWY STE 3600
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2455
Practice Address - Country:US
Practice Address - Phone:830-357-8933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty