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Organization
PRIVY DIAGNOSTICS LABS, LLC
Active
Organization
PRIVY DIAGNOSTICS LABS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAAKA CASH DNP, PMHMP-BC (CEO)
(833) 667-7924
Entity
Organization
Contact information
Practice address
3224 GUS THOMASSON RD STE B, MESQUITE, TX 75150-4004
(833) 667-7924
(817) 755-0945
Mailing address
1230 N KIMBALL AVE STE 130, SOUTHLAKE, TX 76092-4707
(833) 667-7924
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114264199
INDIVIDUAL NPI
TX
05
—
336552
—
TX
Enumeration date
02/28/2022
Last updated
02/28/2022
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