Provider Demographics
NPI: | 1194495135 |
---|---|
Name: | KP BEHAVIORAL LLC |
Entity type: | Organization |
Organization Name: | KP BEHAVIORAL LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER, NP |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KRISTIN |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | SOLIMANI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | NP, DNP |
Authorized Official - Phone: | 972-740-4808 |
Mailing Address - Street 1: | 12700 HILLCREST RD STE 251 |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75230-7134 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-740-4808 |
Mailing Address - Fax: | 949-862-3770 |
Practice Address - Street 1: | 12700 HILLCREST RD STE 251 |
Practice Address - Street 2: | |
Practice Address - City: | DALLAS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75230-7134 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-388-8182 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-09-20 |
Last Update Date: | 2022-08-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |