Individual
SOMSOUK SOUTHICHACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, PMHNP
Contact information
Practice address
3200 W EULESS BLVD, EULESS, TX 76040-6253
(817) 702-3100
(817) 920-6271
Mailing address
PO BOX 732973, DALLAS, TX 75373-2973
(817) 702-8450
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP132679
TX
Other
Enumeration date
04/26/2017
Last updated
11/15/2018
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