Basic Information
| Provider Information | |||||||||
| NPI: | 1972779734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALPHONSO | ||||||||
| FirstName: | HELENE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 732973 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753732973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177028450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 W EULESS BLVD | ||||||||
| Address2: | |||||||||
| City: | EULESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760406253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177023100 | ||||||||
| FaxNumber: | 8179206271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | M9123 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 196106201 | 05 | TX | MEDICAID | 8X5116 | 01 | TX | BCBS | OTHER | P00642497 | 01 | TX | RAILROAD MEDICARE | OTHER |