Provider Demographics
NPI:1922723576
Name:PREMIER BEHAVIORAL HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:PREMIER BEHAVIORAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:N
Authorized Official - Last Name:ASHU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-540-8814
Mailing Address - Street 1:2920 MONTALBO # A
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6506
Mailing Address - Country:US
Mailing Address - Phone:713-540-8814
Mailing Address - Fax:214-765-9240
Practice Address - Street 1:2731 W NORTHWEST HWY STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4782
Practice Address - Country:US
Practice Address - Phone:713-540-8814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty