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General NPI Number Information
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NPI Number | 1245755081
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Entity Type | Organization
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Legal Business Name | WATERSHED GROUP OF DALLAS, PLLC
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Dates
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Enumeration Date | 08/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3600 SHIRE BLVD STE 208
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City | RICHARDSON
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State | TX
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Zip | 75082-2238
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Country | US
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Telephone | 214-556-0996
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 SHIRE BLVD STE 208
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City | RICHARDSON
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State | TX
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Zip | 75082-2238
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Country | US
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Telephone | 214-556-0996
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Fax |
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | MR. LY HAI TRAN
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Credential | LPS-SUPERVISOR
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Telephone | 214-556-0996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 63770
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License Number State | TX
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