MEDICARE: ABC BEHAVIORAL HEALTH, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164404398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC BEHAVIORAL HEALTH, L.L.C.

Provider Business Mailing Address
First Line	:	4600 SAMUELL BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6874
Country	:	US
Telephone Number	:	214-275-8500
Fax Number	:	214-275-6990

Provider Business Practice Location Address
First Line	:	4600 SAMUELL BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6874
Country	:	US
Telephone Number	:	214-275-8500
Fax Number	:	214-275-6990

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	MRS. MELODIE SHATZER
Credential	:	ED.D
Telephone Number	:	214-275-8500

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	09/11/2025

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