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713 W Broad St Forney TX 75126-9147 | |
| (972) 325-2633 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 713 W Broad St, Forney, Texas |
| Authorized Official Name and Position | Blake Serpa (COO CPHM) |
| Authorized Official Contact | 9723252584 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
711 W Broad St Forney TX 75126-9130 Ph: (972) 325-2584 | 713 W Broad St Forney TX 75126-9147 Ph: (972) 325-2633 |
| NPI Number | 1083072862 |
|---|---|
| Provider Enumeration Date | 02/08/2016 |
| Last Update Date | 02/19/2024 |
| Certification Date | 02/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083072862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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