Provider Demographics
NPI:1952859167
Name:BETHESDA MENTAL HEALTH CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:BETHESDA MENTAL HEALTH CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MBAI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:817-350-4377
Mailing Address - Street 1:4101 MCEWEN RD STE 410
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5217
Mailing Address - Country:US
Mailing Address - Phone:817-350-4377
Mailing Address - Fax:817-753-3216
Practice Address - Street 1:4101 MCEWEN RD STE 410
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5217
Practice Address - Country:US
Practice Address - Phone:817-350-4377
Practice Address - Fax:817-753-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124647363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty