Provider Demographics
NPI:1447809983
Name:WITHERSPOON MENTAL HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:WITHERSPOON MENTAL HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:972-716-2969
Mailing Address - Street 1:610 UPTOWN BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3528
Mailing Address - Country:US
Mailing Address - Phone:972-716-2969
Mailing Address - Fax:
Practice Address - Street 1:610 UPTOWN BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3528
Practice Address - Country:US
Practice Address - Phone:972-716-2969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447809983OtherNPI2