Provider Demographics
NPI:1811406150
Name:MEHAN, JUSTIN NEAL (PMHNP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:NEAL
Last Name:MEHAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 CREEKWAY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7564
Mailing Address - Country:US
Mailing Address - Phone:903-808-3499
Mailing Address - Fax:
Practice Address - Street 1:712 N WASHINGTON AVE STE 411
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1626
Practice Address - Country:US
Practice Address - Phone:214-824-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135244363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health