Southern Area Behavioral Healthcare LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

SOUTHERN AREA BEHAVIORAL HEALTHCARE LLC

Practice address

4215 Gannon LN
Dallas, TX 75237-2914

Phone

(972) 283-9090

Fax

(972) 499-0367

NPI assigned

Jun 24, 2009

Last updated

Jan 3, 2024By 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

Kenneth R Medlock

Title

Chief Executive Officer

Phone

(972) 283-9090

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 10

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.

• Thernessia Lashon Bowe, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Irving, TX
  • NPI 1730643511
  Medicare reassignment Care Compare group NPD
• Florence Choi, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Worth, TX
  • NPI 1205266913
  Medicare reassignment Care Compare group NPD
• Celia Ogbe Madu, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Dallas, TX
  • NPI 1932878519
  Medicare reassignment Care Compare group NPD
• Belynda Uzoma Umeh, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Arlington, TX
  • NPI 1750011979
  Medicare reassignment Care Compare group NPD
• David Kwame Dapaah, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Dallas, TX
  • NPI 1659640415
  Medicare reassignment NPD
• Devonn Dillard

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesquite, TX
  • NPI 1740655406
  Medicare reassignment NPD
• April Watkins Moody, LPC

  • Professional Counselor
  • Waxahachie, TX
  • NPI 1942895263
  Medicare reassignment NPD
• Kenneth McRae Rogers, M.D.

  • Psychiatry Physician
  • York, PA
  • NPI 1205844669

  TX

  Medicare reassignment NPD
• Sonya Frank, LCSW

  • Clinical Social Worker
  • Dallas, TX
  • NPI 1912485228
  Medicare reassignment
• Morgan Medlock, MD

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1952749954
  NPD

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1396973772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 GANNON LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752372914",
            "telephone_number": "972-283-9090",
            "fax_number": "972-499-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 GANNON LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752372914",
            "telephone_number": "972-283-9090",
            "fax_number": "972-499-0367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3001 Al Lipscomb Way",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752151702",
            "country_code": "US",
            "telephone_number": "972-283-9090",
            "fax_number": "972-499-0367",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 W Grove St",
            "address_purpose": "LOCATION",
            "city": "Kaufman",
            "state": "TX",
            "postal_code": "751422033",
            "country_code": "US",
            "telephone_number": "972-283-9090",
            "fax_number": "972-499-0367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN AREA BEHAVIORAL HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-24",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "MEDLOCK",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "972-283-9090"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; 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.