Provider Demographics
NPI:1245700640
Name:LIECH, SHEILAH J (PMHNP)
Entity type:Individual
Prefix:
First Name:SHEILAH
Middle Name:J
Last Name:LIECH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 SYLVAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2031
Mailing Address - Country:US
Mailing Address - Phone:214-331-0107
Mailing Address - Fax:
Practice Address - Street 1:1881 SYLVAN AVE # 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2083
Practice Address - Country:US
Practice Address - Phone:214-331-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139657363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health