Provider Demographics
NPI:1942596903
Name:SENIOR PSYCHCARE OF DALLAS I, PLLC
Entity Type:Organization
Organization Name:SENIOR PSYCHCARE OF DALLAS I, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAPART
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:713-850-0049
Mailing Address - Street 1:4635 SOUTHWEST FWY STE 635
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7112
Mailing Address - Country:US
Mailing Address - Phone:713-850-0049
Mailing Address - Fax:713-627-7302
Practice Address - Street 1:4635 SOUTHWEST FWY STE 635
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7112
Practice Address - Country:US
Practice Address - Phone:713-850-0049
Practice Address - Fax:713-627-7302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHIATRIC SERVICES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-28
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288003102Medicaid
TX288003103Medicaid
TX288003104Medicaid
TXDS2656OtherRR MCR HARRIS
TX0095WYOtherBCBS TX
TX288003101Medicaid
TX0095WYOtherBCBS TX
TXTXB139452Medicare PIN
TXTXB146990Medicare PIN
TX288003104Medicaid