Provider Demographics
NPI:1851075683
Name:POTHOS HEALTH
Entity Type:Organization
Organization Name:POTHOS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CARE DIRECTOR/ CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-479-3204
Mailing Address - Street 1:3839 MCKINNEY AVE STE 155
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1488
Mailing Address - Country:US
Mailing Address - Phone:469-319-0292
Mailing Address - Fax:
Practice Address - Street 1:5326 ENCHANTED LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1421
Practice Address - Country:US
Practice Address - Phone:386-479-3204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health