Provider Demographics
NPI:1942689559
Name:TOTAL MENTAL WELLNESS, PLLC
Entity Type:Organization
Organization Name:TOTAL MENTAL WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:MAYORGA
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APN, PMHNP
Authorized Official - Phone:972-712-0591
Mailing Address - Street 1:4072 BRIAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3868
Mailing Address - Country:US
Mailing Address - Phone:972-712-0591
Mailing Address - Fax:972-421-1527
Practice Address - Street 1:2411 VIRGINIA PKWY STE 7
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3508
Practice Address - Country:US
Practice Address - Phone:972-712-0591
Practice Address - Fax:972-421-1527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
TXAP119548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty