East Texas Neurobehavioral Health,PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

33829 Issued in TX

Legal business name

EAST TEXAS NEUROBEHAVIORAL HEALTH,PLLC

Practice address

122 S Gun Barrel LN
Suite 6
Gun Barrel City, TX 75156-9403

Phone

(903) 887-0697

Fax

(903) 887-0698

NPI assigned

May 1, 2012

Last updated

May 1, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Diane M Gard, PH.D.NPI 1831264274

Title

Owner/Clinical Psychologist

Phone

(903) 887-0697

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Diane Marilee Gard, PHD

  • Clinical Psychologist
  • Gun Barrel City, TX
  • NPI 1831264274
  Medicare reassignment NPD Authorized official
• Travis Lee Wacha, FNP-BC, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Palestine, TX
  • NPI 1104374297
  Medicare reassignment NPD
• William Philip Armistead, PHD

  • Psychologist
  • Gun Barrel City, TX
  • NPI 1053235408
  NPD (past)
• Patricia Ann Hatfield-O'Donnell, LCSW

  • Clinical Social Worker
  • Round Rock, TX
  • NPI 1508468877
  NPD (past)
• John Preston Turner, LCSW

  • Clinical Social Worker
  • Gun Barrel City, TX
  • NPI 1841751757
  NPD (past)
• Kristina Michelle Taylor, LCSW

  • Clinical Social Worker
  • Lawrenceville, GA
  • NPI 1609389089
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1114285970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2107",
            "city": "MABANK",
            "state": "TX",
            "postal_code": "751475017",
            "telephone_number": "903-887-0697",
            "fax_number": "903-887-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 S GUN BARREL LN",
            "address_2": "SUITE 6",
            "city": "GUN BARREL CITY",
            "state": "TX",
            "postal_code": "751569403",
            "telephone_number": "903-887-0697",
            "fax_number": "903-887-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS NEUROBEHAVIORAL HEALTH,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "GARD",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "903-887-0697",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "33829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dallas Eye Care Associates PLLC (Dallas Eye Care Associates)
• Mayela Delgado Angeles, PA-C
• Shannon Dickson
• Divine Interventions Nurse Concierge Services, PLLC (P31 Wellness)
• East Texas Community Clinic, Inc.
• Vincent C Egwuonwu, PHARMACIST
• Joseph Gregory Ellis, R.PH.
• Enriched Life Medical (Jon M Rich)
• Enriched Life Medical, PLLC
• Etmc Physician Group Inc.

• Clinical Psychologist in Gun Barrel City, TX
• Providers in Gun Barrel City, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.