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General NPI Number Information
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NPI Number | 1285058768
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Entity Type | Organization
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Legal Business Name | AMPLE HEALTH SERVICES
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 2528 N FITZHUGH AVE
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City | DALLAS
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State | TX
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Zip | 75204-3387
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Country | US
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Telephone | 972-253-0000
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Fax | 214-823-2550
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Provider Business Mailing Address
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Address Line | 2528 NORTH FITZHUGH AVENUE
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City | DALLAS
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State | TX
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Zip | 75204-3387
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Country | US
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Telephone | 972-253-0000
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Fax | 214-823-2550
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | EDDIE CHIEDOZIE OSUAGWU
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Credential | LPCI/LCDC, M.ED, M.S
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Telephone | 972-253-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 70461
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License Number State | TX
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