Healthcare Provider Details

I. General information

NPI: 1316893167
Provider Name (Legal Business Name): THE SELF CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11324 GEORGE RENFRO DRIVE SUITE F
LILLIAN TX
76061
US

IV. Provider business mailing address

11324 GEORGE RENFRO DRIVE SUITE F
LILLIAN TX
76061
US

V. Phone/Fax

Practice location:
  • Phone: 214-444-3246
  • Fax:
Mailing address:
  • Phone: 214-444-3246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MILDA ALIS ALIS CUMMINGS
Title or Position: CO-OWNER
Credential: PMHNP
Phone: 862-333-8792