Healthcare Provider Details

I. General information

NPI: 1164404398
Provider Name (Legal Business Name): ABC BEHAVIORAL HEALTH, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SAMUELL BLVD
DALLAS TX
75228-6874
US

IV. Provider business mailing address

4600 SAMUELL BLVD
DALLAS TX
75228-6874
US

V. Phone/Fax

Practice location:
  • Phone: 214-275-8500
  • Fax: 214-275-6990
Mailing address:
  • Phone: 214-275-8500
  • Fax: 214-275-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELODIE SHATZER
Title or Position: PRESIDENT, CEO
Credential: ED.D
Phone: 214-275-8500