Healthcare Provider Details

I. General information

NPI: 1467775510
Provider Name (Legal Business Name): FIRST STEP DENTON COUNTY OUTREACH PROGRAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 N CORINTH ST STE 401
CORINTH TX
76208-5449
US

IV. Provider business mailing address

1406 NORTH CORINTH STREET SUITE 401
CORINTH TX
76208-5449
US

V. Phone/Fax

Practice location:
  • Phone: 940-497-5576
  • Fax: 940-497-5585
Mailing address:
  • Phone: 940-497-5576
  • Fax: 940-497-5585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5244
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5244
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5244
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number5244
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5244
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5244
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number5244
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5244
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number5244
License Number StateTX
# 10
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5244
License Number StateTX
# 11
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number5244
License Number StateTX
# 12
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROY EDWARD CULBERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 940-497-5576