=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992072342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PLAN OF NORTH TEXAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2011
-----------------------------------------------------
Last Update Date | 11/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13151 EMILY RD SUITE. 240
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-8989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-690-7526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13151 EMILY RD SUITE. 240
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-690-7526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CLINICAL SERVICES
-----------------------------------------------------
Name | ROB NOVICK
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 972-690-7526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 35110
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------