Provider Demographics
NPI:1851714166
Name:GENUINE LIFE WELLNESS PLLC
Entity Type:Organization
Organization Name:GENUINE LIFE WELLNESS PLLC
Other - Org Name:GENUINE LIFE PSYCHOLOGY & WELLNESS PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SINGLE MEMBER, LICENSED PSYCHOLOGIS
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-742-2186
Mailing Address - Street 1:8340 MEADOW RD STE 224
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0326
Mailing Address - Country:US
Mailing Address - Phone:972-742-2186
Mailing Address - Fax:469-232-9943
Practice Address - Street 1:8340 MEADOW RD STE 224
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0326
Practice Address - Country:US
Practice Address - Phone:972-742-2186
Practice Address - Fax:469-232-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty