MEDICARE: GIFTED SOULS MENTAL HEALTH COMMUNITY CENTER LLC

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1821942871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED SOULS MENTAL HEALTH COMMUNITY CENTER LLC

Provider Business Mailing Address
First Line	:	5001 CROZIER ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-4607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 CROZIER ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-4607
Country	:	US
Telephone Number	:	214-723-0529
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANDRE LAMONT MAYO
Credential	:
Telephone Number	:	214-731-6838

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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