| Molina Psychiatric Associates Pa | |
|
1100 E Southlake Blvd Ste 300 Southlake TX 76092-6350 | |
| (817) 873-0595 | |
| (817) 873-0596 |
| Full Name | Molina Psychiatric Associates Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1100 E Southlake Blvd Ste 300, Southlake, Texas |
| Authorized Official Name and Position | Ana Luckhart (PMHNP) |
| Authorized Official Contact | 8178730595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Molina Psychiatric Associates Pa 1100 E Southlake Blvd Ste 300 Southlake TX 76092-6350 Ph: (817) 873-0595 | Molina Psychiatric Associates Pa 1100 E Southlake Blvd Ste 300 Southlake TX 76092-6350 Ph: (817) 873-0595 |
| NPI Number | 1831756303 |
|---|---|
| Provider Enumeration Date | 05/21/2019 |
| Last Update Date | 06/20/2019 |
| Medicare PECOS PAC ID | 4587991625 |
|---|---|
| Medicare Enrollment ID | O20190812002579 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831756303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Rodolfo Molina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083619605 PECOS PAC ID: 6103001375 Enrollment ID: I20110503000664 |
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