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General NPI Number Information
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NPI Number | 1386845915
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Entity Type | Organization
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Legal Business Name | TEXOMA COMMUNITY CENTER
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 315 W MCLAIN DR
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City | SHERMAN
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State | TX
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Zip | 75092-2605
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Country | US
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Telephone | 903-957-4869
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Fax | 903-957-3416
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Provider Business Mailing Address
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Address Line | PO BOX 1087
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City | SHERMAN
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State | TX
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Zip | 75091-1087
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Country | US
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Telephone | 903-957-4861
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Fax | 903-957-3416
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DANIEL THOMPSON
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Credential |
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Telephone | 903-957-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 580930
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA05480
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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