IndividualActive
Jennifer Premo, EDDIAGNOSTICIANMED
NPI 1083229611 · Adolescent and Children Mental Health Clinic/Center · Dallas, TX
Provider details
- NPI number
- 1083229611
- Entity type
- Individual
- Primary specialty
- Adolescent and Children Mental Health Clinic/CenterAmbulatory Health Care Facilities
- Credential
- EDDIAGNOSTICIANMED
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Ambulatory Health Care Facilities
- Case Management Agency251B00000X
Agencies
- Community/Behavioral Health Agency251S00000X
Agencies
- Adult Mental Health Clinic/Center261QM0850X
Ambulatory Health Care Facilities
Practice location
4125 Beechwood Ln
Dallas, TX 75220-1905
Phone: (214) 532-6726
Approximate (ZIP-level) locationGet directions
Mailing address
4125 Beechwood Ln
Dallas, TX 75220-1905
Registry dates
- Enumerated
- 2020-09-10
- Last updated
- 2020-09-10
- Certified
- 2020-09-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.