| Brilliant Mind Behavioral Services Llc | |
|
2770 Main St Ste 211 Frisco TX 75033-4439 | |
| (469) 618-5703 | |
| Not Available |
| Full Name | Brilliant Mind Behavioral Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2770 Main St Ste 211, Frisco, Texas |
| Authorized Official Name and Position | Shelmith Mamo (PROVIDER) |
| Authorized Official Contact | 4696185703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brilliant Mind Behavioral Services Llc 2770 Main St Ste 211 Frisco TX 75033-4439 Ph: () - | Brilliant Mind Behavioral Services Llc 2770 Main St Ste 211 Frisco TX 75033-4439 Ph: (469) 618-5703 |
| NPI Number | 1679923163 |
|---|---|
| Provider Enumeration Date | 06/15/2016 |
| Last Update Date | 02/20/2017 |
| Medicare PECOS PAC ID | 7517246978 |
|---|---|
| Medicare Enrollment ID | O20161108001735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679923163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | AP126843 (Texas) | Primary |
| Provider Name | Shelmith Mamo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194122341 PECOS PAC ID: 8426337882 Enrollment ID: I20161108001916 |
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