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General NPI Number Information
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NPI Number | 1124664123
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Entity Type | Organization
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Legal Business Name | CHARIS BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 250 W SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6171
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Country | US
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Telephone | 469-578-2529
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Fax |
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Provider Business Mailing Address
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Address Line | 250 W SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6170
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Country | US
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Telephone | 817-997-4525
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Fax |
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Authorized Official
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Title or Position | BUSINESS OPERATIONS DIRECTOR
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Name | COSALYN YOUNG
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Credential |
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Telephone | 817-997-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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