MEDICARE: SUNDANCE BEHAVIORAL HEALTH CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB135639	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235157165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNDANCE BEHAVIORAL HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	7000 HIGHWAY 287
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-2805
Country	:	US
Telephone Number	:	817-583-8080
Fax Number	:	817-483-1572

Provider Business Practice Location Address
First Line	:	2707 AIRPORT FWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-2370
Country	:	US
Telephone Number	:	817-222-9191
Fax Number	:	817-222-9797

Authorized Official
Title or Position	:	OWNER
Name	:	PADMANABHA RAJU INDUKURI
Credential	:
Telephone Number	:	817-222-9191

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	03/10/2017

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Directions to “SUNDANCE BEHAVIORAL HEALTH CARE, INC ” Practice Location

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