Provider Demographics
NPI:1124347026
Name:NEUROWELLNESS
Entity type:Organization
Organization Name:NEUROWELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DIR OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-386-9776
Mailing Address - Street 1:5310 HARVEST HILL RD
Mailing Address - Street 2:SUITE 165
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5806
Mailing Address - Country:US
Mailing Address - Phone:972-386-9776
Mailing Address - Fax:972-365-3171
Practice Address - Street 1:5310 HARVEST HILL RD
Practice Address - Street 2:SUITE 165
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-5806
Practice Address - Country:US
Practice Address - Phone:972-386-9776
Practice Address - Fax:972-365-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7388101Y00000X
TX437106H00000X
TXAC01124171100000X
TXMFC 7388 437103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty