Healthcare Provider Details

I. General information

NPI: 1689841751
Provider Name (Legal Business Name): EASTER SEALS NORTH TEXAS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W NASH ST
GRAPEVINE TX
76051-5512
US

IV. Provider business mailing address

1424 HEMPHILL ST
FORT WORTH TX
76104-4703
US

V. Phone/Fax

Practice location:
  • Phone: 817-424-9797
  • Fax: 817-424-9792
Mailing address:
  • Phone: 888-617-7171
  • Fax: 817-332-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA DEMPSEY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 817-759-7925