Provider Demographics
NPI:1194287896
Name:OPTASIA BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:OPTASIA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, BCBA-LBA
Authorized Official - Phone:469-396-4314
Mailing Address - Street 1:3918 POPLAR POINT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-9275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:469-533-8848
Practice Address - Street 1:406 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-5610
Practice Address - Country:US
Practice Address - Phone:469-396-4314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)