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General NPI Number Information
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NPI Number | 1245857416
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Entity Type | Organization
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Legal Business Name | MAZE OF LIFE RESOURCE CENTER
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 12700 HILLCREST RD STE 125
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City | DALLAS
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State | TX
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Zip | 75230-2009
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Country | US
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Telephone | 469-848-8660
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Fax | 312-300-2010
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Provider Business Mailing Address
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Address Line | 12700 HILLCREST RD STE 125
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City | DALLAS
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State | TX
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Zip | 75230-2009
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Country | US
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Telephone | 469-848-8660
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Fax | 312-300-2010
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. KASEY NICOLE TYLER
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Credential | CAMS
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Telephone | 469-848-8660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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