1659336345 NPI number — CHILD AND FAMILY GUIDANCE CENTER OF TEXOMA

Table of content: (NPI 1659336345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659336345 NPI number — CHILD AND FAMILY GUIDANCE CENTER OF TEXOMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILD AND FAMILY GUIDANCE CENTER OF TEXOMA
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:
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:
1659336345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
804 PECAN GROVE RD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75090-1767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-893-7768
Provider Business Mailing Address Fax Number:
903-893-4979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 PECAN GROVE RD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75090-1767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-893-7768
Provider Business Practice Location Address Fax Number:
903-893-4979
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYWARD
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
903-893-7768

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  14846 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 17819 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 18459 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 901 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 16486 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 17384 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 18185 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 27693 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 11588 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 82844L . This is a "INDIVIDUAL BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 83590L . This is a "INDIVIDUAL BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 084154602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5390719 . This is a "INDIVIDUAL AETNA NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00N35N . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 83343L . This is a "INDIVIDUAL BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 87190Q . This is a "INDIVIDUAL BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84347L . This is a "INDIVIDUAL BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 084154601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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