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General NPI Number Information
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NPI Number | 1740504836
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Entity Type | Organization
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Legal Business Name | T.E.A.M., INC
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 609 N EBRITE ST SUITE 111
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City | MESQUITE
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State | TX
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Zip | 75149-3478
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Country | US
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Telephone | 972-289-0040
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Fax | 972-289-0042
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Provider Business Mailing Address
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Address Line | 609 N EBRITE ST SUITE 111
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City | MESQUITE
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State | TX
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Zip | 75149-3478
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Country | US
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Telephone | 972-289-0040
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Fax | 972-289-0042
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Authorized Official
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Title or Position | TEXAS SOCIAL WORKER
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Name | MR. EDMOND S MAXON III
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Credential | LBSW
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Telephone | 972-289-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22799
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License Number State | TX
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