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General NPI Number Information
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NPI Number | 1740855931
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Entity Type | Organization
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Legal Business Name | FOREVER CARE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 3626 NORTH HALL STREET (TWO OAK LAWN), STE 610
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City | DALLAS
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State | TX
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Zip | 75219
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Country | US
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Telephone | 972-784-1129
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Fax |
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Provider Business Mailing Address
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Address Line | 3626 NORTH HALL STREET (TWO OAK LAWN), STE 610
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City | DALLAS
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State | TX
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Zip | 75219
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Country | US
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Telephone | 972-784-1129
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | DEISHONDA GREENWOOD
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Credential |
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Telephone | 504-399-1161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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