Whalio Doctors

NPI 1023625894

Destination Life Llc-S

Organisation Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist Ellisville, MS

Practice location

Address
7 Jonathan Way, Ellisville, MS 39437-5195
Phone
(817) 473-1312
Fax
(866) 990-2813
Mailing address
2001 SE Green Oak Blvd STE 130, Arlington, TX 76018-0952

Authorised official

Name
Zemelda D. Carr
Title
Adm
Phone
(817) 473-1312

Registered specialties (15)

Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist Primary
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 364SP0807X
Clinical Social Worker
Behavioral Health & Social Service Providers Taxonomy 1041C0700X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Nursing Service Providers Taxonomy 163WP0807X
Occupational Therapist
Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225X00000X
Mental Health Occupational Therapist
Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225XM0800X
Primary Care Clinic/Center
Ambulatory Health Care Facilities Taxonomy 261QP2300X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Ambulatory Health Care Facilities Taxonomy 261QR0401X
Clinical Medical Laboratory
Laboratories Taxonomy 291U00000X
Nurse Practitioner
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363L00000X
Community Health Nurse Practitioner
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LC1500X
Family Nurse Practitioner
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LF0000X
Psychiatric/Mental Health Nurse Practitioner
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LP0808X
Women's Health Nurse Practitioner
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LW0102X
Clinical Nurse Specialist
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 364S00000X
Psychiatric/Mental Health Clinical Nurse Specialist
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 364SP0808X

Registry record

NPI
1023625894
Entity type
Organization
NPI issued
25 Sep 2020
Record last updated
30 Jul 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.