Southern Area Behavioral Healthcare LLC
NPI 1396973772 · Psychiatry Physician · Dallas, TX
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1396973772
- Entity type
- Organization
- Primary specialty
- Psychiatry PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kenneth Medlock, Chief Executive Officer(972) 283-9090
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Professional Counselor101YP2500X
Behavioral Health & Social Service Providers
- Case Manager/Care Coordinator171M00000X
Other Service Providers
- Case Management Agency251B00000X
Agencies
Ambulatory Health Care Facilities
- Adult Mental Health Clinic/Center261QM0850X
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
3 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (2)
- 3001 Al Lipscomb WayDallas, TX 75215-1702Phone: (972) 283-9090Fax: (972) 499-0367
- 110 W Grove StKaufman, TX 75142-2033Phone: (972) 283-9090Fax: (972) 499-0367
Registry dates
- Enumerated
- 2009-06-24
- Last updated
- 2024-01-03
- Certified
- 2024-01-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.