Individual
JENNIFER URBANI PREMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDDIAGNOSTICIANMED
Contact information
Practice address
4125 BEECHWOOD LN, DALLAS, TX 75220-1905
(214) 532-6726
Mailing address
4125 BEECHWOOD LN, DALLAS, TX 75220-1905
(214) 532-6726
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
TX
251S00000X
Community/Behavioral Health Agency
—
TX
261QM0850X
Adult Mental Health Clinic/Center
—
TX
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
TX
Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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