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General NPI Number Information
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NPI Number | 1740870005
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Entity Type | Organization
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Legal Business Name | GIFTED SOULS MENTAL HEALTH COMMUNITY CENTER LLC
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 17480 DALLAS PKWY STE 213
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City | DALLAS
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State | TX
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Zip | 75287-7304
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Country | US
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Telephone | 469-510-4291
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Fax |
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Provider Business Mailing Address
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Address Line | 17480 DALLAS PKWY STE 213
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City | DALLAS
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State | TX
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Zip | 75287-7304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE MAYO
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Credential |
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Telephone | 469-510-4291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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