MEDICARE: PROJECT 75216

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1336023530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT 75216

Provider Business Mailing Address
First Line	:	2431 S MARSALIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-2316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 S MARSALIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-2316
Country	:	US
Telephone Number	:	214-941-2531
Fax Number	:

Authorized Official
Title or Position	:	BOARD CHAIR
Name	:	MR. WILLIAM L ROSS
Credential	:	LPC
Telephone Number	:	214-941-2531

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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