1023239886 NPI number — DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER

Table of content: PRINCESS CEMONE FREDERICK LCMHC, NCC (NPI 1063163004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023239886 NPI number — DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS COUNTY MENTAL HEALTH & MENTAL RETARDATION CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023239886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 RIVER BEND DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75247-6945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-743-1200
Provider Business Mailing Address Fax Number:
214-689-6482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1345 RIVER BEND DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75247-6945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-743-1200
Provider Business Practice Location Address Fax Number:
214-689-6482
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAOS
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
214-743-1200

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084F0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0630X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 137252607 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".