Healthcare Provider Details

I. General information

NPI: 1659336345
Provider Name (Legal Business Name): CHILD AND FAMILY GUIDANCE CENTER OF TEXOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 PECAN GROVE RD E
SHERMAN TX
75090-1767
US

IV. Provider business mailing address

804 PECAN GROVE RD E
SHERMAN TX
75090-1767
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-7768
  • Fax: 903-893-4979
Mailing address:
  • Phone: 903-893-7768
  • Fax: 903-893-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14846
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17819
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18459
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number901
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16486
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17384
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18185
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27693
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11588
License Number StateTX

VIII. Authorized Official

Name: BRENDA HAYWARD
Title or Position: EXECUTIVE DIRECTOR
Credential: M.B.A.
Phone: 903-893-7768