Provider Demographics
NPI:1689024424
Name:RECONCILE CARE MANAGEMENT SERVICES, PLLC
Entity Type:Organization
Organization Name:RECONCILE CARE MANAGEMENT SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN CCM
Authorized Official - Phone:682-556-8472
Mailing Address - Street 1:2541 CLEARLAKE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6824
Mailing Address - Country:US
Mailing Address - Phone:682-556-8472
Mailing Address - Fax:
Practice Address - Street 1:2541 CLEARLAKE DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6824
Practice Address - Country:US
Practice Address - Phone:682-556-8472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776453163W00000X, 163WA2000X, 163WC0400X, 163WC1500X, 163WC1600X, 163WG0600X, 163WP0807X, 163WP0808X, 163WX0106X
TN776453163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff DevelopmentGroup - Single Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Single Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
No163WX0106XNursing Service ProvidersRegistered NurseOccupational HealthGroup - Single Specialty