Provider Demographics
NPI:1740451608
Name:BIOFEEDBACK & BEHAVIORAL HEALTHCARE SOLUTIONS, P.A.
Entity type:Organization
Organization Name:BIOFEEDBACK & BEHAVIORAL HEALTHCARE SOLUTIONS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-662-0044
Mailing Address - Street 1:5995 SUMMERSIDE DR # 5098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-0002
Mailing Address - Country:US
Mailing Address - Phone:214-662-0044
Mailing Address - Fax:
Practice Address - Street 1:5995 SUMMERSIDE DR UNIT 795098
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75379-0092
Practice Address - Country:US
Practice Address - Phone:214-662-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170206001Medicaid
TX170206001Medicaid
TX0A5464Medicare PIN
TX0A5463Medicare PIN