Provider Demographics
NPI:1578018073
Name:ARISE BEHAVIORAL AND WELLNESS HEALTH
Entity Type:Organization
Organization Name:ARISE BEHAVIORAL AND WELLNESS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:KUTESA
Authorized Official - Last Name:BICKERSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-249-9717
Mailing Address - Street 1:1505 W JEFFERSON ST STE 155
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2223
Mailing Address - Country:US
Mailing Address - Phone:469-550-2031
Mailing Address - Fax:469-550-2039
Practice Address - Street 1:1505 W JEFFERSON ST STE 155
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2223
Practice Address - Country:US
Practice Address - Phone:469-550-2031
Practice Address - Fax:469-550-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130637251S00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251S00000XAgenciesCommunity/Behavioral Health