Provider Demographics
NPI:1548961550
Name:MIND-TOUCH PSYCHIATRY & INTEGRATIVE CARE, LLC
Entity type:Organization
Organization Name:MIND-TOUCH PSYCHIATRY & INTEGRATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL COORD
Authorized Official - Prefix:
Authorized Official - First Name:TRALICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:469-586-7643
Mailing Address - Street 1:5900 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:405-922-5280
Mailing Address - Fax:
Practice Address - Street 1:391 LAS COLINAS BLVD E STE 130
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-6225
Practice Address - Country:US
Practice Address - Phone:682-263-1695
Practice Address - Fax:682-228-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty