| East Texas Neurobehavioral Health,pllc | |
|
122 S Gun Barrel Ln Suite 6 Gun Barrel City TX 75156-9403 | |
| (903) 887-0697 | |
| (903) 887-0698 |
| Full Name | East Texas Neurobehavioral Health,pllc |
|---|---|
| Speciality | Psychologist |
| Location | 122 S Gun Barrel Ln, Gun Barrel City, Texas |
| Authorized Official Name and Position | Diane M Gard (OWNER/CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9038870697 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Texas Neurobehavioral Health,pllc Po Box 2107 Mabank TX 75147-5017 Ph: (903) 887-0697 | East Texas Neurobehavioral Health,pllc 122 S Gun Barrel Ln Suite 6 Gun Barrel City TX 75156-9403 Ph: (903) 887-0697 |
| NPI Number | 1114285970 |
|---|---|
| Provider Enumeration Date | 05/01/2012 |
| Last Update Date | 05/01/2012 |
| Medicare PECOS PAC ID | 9830351147 |
|---|---|
| Medicare Enrollment ID | O20120503000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114285970 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 33829 (Texas) | Primary |
| Provider Name | Diane M Gard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831264274 PECOS PAC ID: 2264428911 Enrollment ID: I20100219000323 |
| Provider Name | Travis L Wacha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104374297 PECOS PAC ID: 2062792690 Enrollment ID: I20161216001372 |
Cedar Creek Wellness Group Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1837 W Main St, Gun Barrel City, TX 75156 Phone: 903-910-2294 Fax: 949-577-4350 |