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General NPI Number Information
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NPI Number | 1790026359
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Entity Type | Organization
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Legal Business Name | TYS LLC DBA SOUTHWEST CONSULTING
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 1402 CORINTH ST SUITE 219
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City | DALLAS
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State | TX
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Zip | 75215-2111
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Country | US
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Telephone | 469-360-7453
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 CORINTH ST SUITE 219
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City | DALLAS
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State | TX
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Zip | 75215-2111
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Country | US
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Telephone | 469-360-7453
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | PRISCILLA SOUZA
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Credential | PHD
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Telephone | 469-360-7453
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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 | 32008
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License Number State | TX
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