=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558771014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIANS FOR CHILDREN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2014
-----------------------------------------------------
Last Update Date | 02/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2350 N STEMMONS FWY
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75207-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-488-7100
-----------------------------------------------------
Fax | 469-488-7101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2777 N STEMMONS FWY STE 825
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75207-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-456-4450
-----------------------------------------------------
Fax | 214-456-4490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR. DIRECTOR
-----------------------------------------------------
Name | ADAM MELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-456-0039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------