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General NPI Number Information
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NPI Number | 1821092677
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Entity Type | Organization
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Legal Business Name | ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 913 N JACKSON ST
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City | JACKSONVILLE
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State | TX
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Zip | 75766-3801
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Country | US
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Telephone | 903-586-5507
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Fax | 903-586-4234
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Provider Business Mailing Address
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Address Line | 913 N JACKSON ST
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City | JACKSONVILLE
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State | TX
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Zip | 75766-3801
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Country | US
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Telephone | 903-586-5507
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Fax | 903-586-4234
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ALLYN LANG
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Credential |
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Telephone | 903-586-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State | TX
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