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General NPI Number Information
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NPI Number | 1194090084
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Entity Type | Organization
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Legal Business Name | COLLIN COUNTY ADULT CLINIC
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 2520 K AVENUE, SUITE 100
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City | PLANO
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State | TX
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Zip | 75074
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Country | US
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Telephone | 972-423-4941
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Fax | 972-423-2020
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Provider Business Mailing Address
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Address Line | 2520 K AVENUE, SUITE 100
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City | PLANO
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State | TX
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Zip | 75074
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Country | US
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Telephone | 972-423-4941
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Fax | 972-423-2020
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JORDAN DANIEL ROBINSON
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Credential | J.D.,MHA
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Telephone | 972-423-4941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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