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General NPI Number Information
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NPI Number | 1952542813
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Entity Type | Organization
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Legal Business Name | TEXAS HEALTH
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 185 EASTGATE PLZ
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City | WACO
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State | TX
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Zip | 76705-2868
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Country | US
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Telephone | 254-412-2667
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Fax | 254-799-5768
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Provider Business Mailing Address
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Address Line | 5445 LA SIERRA DR SUITE 204
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City | DALLAS
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State | TX
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Zip | 75231-4139
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Country | US
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Telephone | 214-692-6666
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Fax | 214-692-6670
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Authorized Official
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Title or Position | LPC, CLINICAL SUPERVISOR
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Name | PHIL BOHART
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Credential | MS,CRC,LPC#15980
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Telephone | 214-692-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 63195
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License Number State | TX
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