MEDICARE: ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES

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	103T00000X	Psychologist		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00T09Z	OTHER	TX	BLUE CROSS &BLUE SHIEILD

General Provider Information

NPI Number	:	1497759237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES

Provider Business Mailing Address
First Line	:	913 N JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-3801
Country	:	US
Telephone Number	:	903-586-5507
Fax Number	:	903-586-4234

Provider Business Practice Location Address
First Line	:	5656 N JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9641
Country	:	US
Telephone Number	:	903-589-9000
Fax Number	:	903-586-9200

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ALLYN LANG
Credential	:
Telephone Number	:	903-586-5507

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/21/2022

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