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General NPI Number Information
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NPI Number | 1336417427
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Entity Type | Organization
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Legal Business Name | RED BIRD EDUCATION PROGRAMS
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 4549 S WESTMORELAND RD
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City | DALLAS
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State | TX
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Zip | 75237-1015
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Country | US
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Telephone | 214-287-3501
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Fax | 214-623-0322
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Provider Business Mailing Address
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Address Line | 4549 S WESTMORELAND RD
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City | DALLAS
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State | TX
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Zip | 75237-1015
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Country | US
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Telephone | 214-287-3501
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Fax | 214-623-0322
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Authorized Official
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Title or Position | CEO
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Name | MR. MARK CONAL O'NEAL
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Credential | LCDC
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Telephone | 214-475-3712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 8925
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License Number State | TX
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