1053545335 NPI number — BEACON BEHAVIORAL OF TEXAS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053545335 NPI number — BEACON BEHAVIORAL OF TEXAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEACON BEHAVIORAL OF TEXAS PA
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:
1053545335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 PRESTIGE CIRCLE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-383-3200
Provider Business Mailing Address Fax Number:
214-383-3211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 PRESTIGE CIRCLE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-383-3200
Provider Business Practice Location Address Fax Number:
214-383-3211
Provider Enumeration Date:
05/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
THOMASON
Authorized Official First Name:
ALEXIS
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE MANAGEMEN
Authorized Official Telephone Number:
225-436-2529

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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