Organization
K CHISOLM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMARIA CHISOLM PH.D., LCP (PSYCHOLOGIST)
(240) 642-1400
Entity
Organization
Contact information
Practice address
1710 BELLA LN, MANSFIELD, TX 76063-4470
(240) 642-1400
Mailing address
PO BOX 1743, MANSFIELD, TX 76063-0010
(240) 642-1400
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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