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General NPI Number Information
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NPI Number | 1558537217
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Entity Type | Organization
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Legal Business Name | PLAN
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 13150 EMILY ROAD 240
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City | DALLAS
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State | TX
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Zip | 75240
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Country | US
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Telephone | 972-690-7526
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Fax |
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Provider Business Mailing Address
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Address Line | 13150 EMILY RD 240
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City | DALLAS
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State | TX
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Zip | 75240
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Country | US
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Telephone | 972-690-7526
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. PATTY ANDERSON
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Credential | LCSW
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Telephone | 972-690-7526
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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 | 1041C0700X
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License Number State | TX
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