Healthcare Provider Details

I. General information

NPI: 1467997627
Provider Name (Legal Business Name): FAMILY AND CHILD GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 W PLANO PKWY SUITE 211
PLANO TX
75093-5619
US

IV. Provider business mailing address

8915 HARRY HINES BLVD
DALLAS TX
75235-1717
US

V. Phone/Fax

Practice location:
  • Phone: 214-351-3490
  • Fax:
Mailing address:
  • Phone: 214-351-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateTX

VIII. Authorized Official

Name: JEFF KEEHN
Title or Position: CFO
Credential:
Phone: 214-351-3490