Healthcare Provider Details

I. General information

NPI: 1700639168
Provider Name (Legal Business Name): SERENITY YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 TRACY AVE
DUNCANVILLE TX
75137-3550
US

IV. Provider business mailing address

1011 TRACY AVE
DUNCANVILLE TX
75137-3550
US

V. Phone/Fax

Practice location:
  • Phone: 469-600-6366
  • Fax: 972-637-7511
Mailing address:
  • Phone: 469-600-6366
  • Fax: 972-637-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LYNDA JOHNSON
Title or Position: DIRECTOR
Credential: PSYD. LPCS
Phone: 469-600-6366