MEDICARE: NORTH TEXAS COMMUNITY INITIATIVE, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1306202411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS COMMUNITY INITIATIVE, INC.

Provider Business Mailing Address
First Line	:	5811 GLOUCESTER CT
Second Line	:	SUITE 101
City	:	ARLINGTON
State	:	TX
Zip	:	76018-2384
Country	:	US
Telephone Number	:	214-680-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	5811 GLOUCESTER CT
Second Line	:	SUITE 101
City	:	ARLINGTON
State	:	TX
Zip	:	76018-2384
Country	:	US
Telephone Number	:	214-680-5553
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. JAMES A. GARNER
Credential	:	PH.D.
Telephone Number	:	214-680-5553

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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