MEDICARE: FIRST STEP DENTON COUNTY OUTREACH PROGRAM

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	3160-3161	TX
2	101YP2500X	Professional Counselor	3160-3161	TX
3	103TA0400X	Addiction (Substance Use Disorder) Psychologist	3160-3161	TX
4	103TB0200X	Cognitive & Behavioral Psychologist	3160-3161	TX
5	103TC0700X	Clinical Psychologist	3160-3161	TX
6	103TC1900X	Counseling Psychologist	3160-3161	TX
7	103TP2701X	Group Psychotherapy Psychologist	3160-3161	TX
8	103TR0400X	Rehabilitation Psychologist	3160-3161	TX
9	171100000X	Acupuncturist	3160-3161	TX
10	251300000X	Local Education Agency (LEA)
11	251C00000X	Developmentally Disabled Services Day Training Agency	3160-3161	TX
12	251E00000X	Home Health Agency	3160-3161	TX
13	251S00000X	Community/Behavioral Health Agency	3160-3161	TX
14	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	3160-3161	TX

General Provider Information

NPI Number	:	1811217789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEP DENTON COUNTY OUTREACH PROGRAM

Provider Business Mailing Address
First Line	:	1310 TEASLEY LN
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7946
Country	:	US
Telephone Number	:	940-484-7837
Fax Number	:	940-484-7835

Provider Business Practice Location Address
First Line	:	1310 TEASLEY LN
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7946
Country	:	US
Telephone Number	:	940-484-7837
Fax Number	:	940-484-7835

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROY EDWARD CULBERSON
Credential	:
Telephone Number	:	940-484-7837

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	06/02/2010

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