Provider Demographics
NPI:1750080081
Name:EVEREST FUNCTIONAL PSYCHIATRY AND WELLNESS, PLLC
Entity type:Organization
Organization Name:EVEREST FUNCTIONAL PSYCHIATRY AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EVEREST
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-839-8466
Mailing Address - Street 1:8222 DOUGLAS AVE STE 375
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5973
Mailing Address - Country:US
Mailing Address - Phone:972-839-8466
Mailing Address - Fax:
Practice Address - Street 1:8222 DOUGLAS AVE STE 375
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5973
Practice Address - Country:US
Practice Address - Phone:972-839-8466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477211332OtherNPI