Organization
NORTH TEXAS BRAIN AND WELLNESS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA ASHLEY-ESCOTO (PRESIDENT)
(817) 580-7678
Entity
Organization
Contact information
Practice address
241 W. SOUTHLAKE BLVD., SUITE 140, SOUTHLAKE, TX 76092
(817) 580-7678
(817) 580-7891
Mailing address
PO BOX 470606, FORT WORTH, TX 76147-0606
(817) 580-7678
(817) 580-7891
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
111N00000X
Chiropractor
—
—
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
—
—
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
—
—
225700000X
Massage Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/21/2019
Last updated
07/12/2021
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