Healthcare Provider Details

I. General information

NPI: 1326292087
Provider Name (Legal Business Name): CUMBERLAND PRESBYTERIAN CHILDREN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 BERNARD ST.
DENTON TX
76202
US

IV. Provider business mailing address

1304 BERNARD ST. P.O. DRAWER G
DENTON TX
76202-1687
US

V. Phone/Fax

Practice location:
  • Phone: 940-382-5112
  • Fax: 940-387-0821
Mailing address:
  • Phone: 940-382-5112
  • Fax: 940-387-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15780
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number15780
License Number StateTX

VIII. Authorized Official

Name: AMY A WATSON
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: LPC
Phone: 940-382-5112