# CUSTOMMADEIMAGEHEALTH AND WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417730631
- **Authorized official:** TONYA WILLIAMS (NURSE PRACTITIONER)
- **Authorized official phone:** (214) 945-3702

## Contact information

- **Practice address:** 825 WATTERS CREEK BLVD STE 250, ALLEN, TX 75013-3770
- **Practice address phone:** (214) 945-3702
- **Mailing address:** 1972 SUNNY SIDE DR, LITTLE ELM, TX 75068-7803
- **Mailing address phone:** (214) 797-8767

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0809X | Adult Psychiatric/Mental Health Registered Nurse | — | NULL | Yes |
| 163WP0809X | Adult Psychiatric/Mental Health Registered Nurse | — | — | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/14/2023
- **Last updated:** 08/14/2023