| Deprece Supportive Services, Llc | |
|
1500 Grace Lane St Paul TX 75098 | |
| (469) 670-7265 | |
| Not Available |
| Full Name | Deprece Supportive Services, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1500 Grace Lane, St Paul, Texas |
| Authorized Official Name and Position | Leontyne Gulley Williams (OWNER) |
| Authorized Official Contact | 2055877040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Deprece Supportive Services, Llc 1500 Grace Ln St Paul TX 75098-1873 Ph: (205) 587-7040 | Deprece Supportive Services, Llc 1500 Grace Lane St Paul TX 75098 Ph: (469) 670-7265 |
| NPI Number | 1043802325 |
|---|---|
| Provider Enumeration Date | 02/08/2021 |
| Last Update Date | 02/08/2021 |
| Certification Date | 01/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043802325 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |