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General NPI Number Information
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NPI Number | 1184415853
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Entity Type | Organization
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Legal Business Name | THE FOUR FIVE
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 114 PUGH LN
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City | CORSICANA
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State | TX
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Zip | 75109-5420
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Country | US
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Telephone | 972-806-0877
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Fax |
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Provider Business Mailing Address
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Address Line | 5954 BROADWAY BLVD # 105
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City | GARLAND
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State | TX
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Zip | 75043-5822
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Country | US
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Telephone | 972-806-0877
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | CHANCE WILLIAM LUNA
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Credential | LCDC
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Telephone | 972-806-0877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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