| Ivory Park Pllc | |
|
3824 Cedar Springs Rd # 153 Dallas TX 75219-4136 | |
| (469) 634-0050 | |
| Not Available |
| Full Name | Ivory Park Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3824 Cedar Springs Rd # 153, Dallas, Texas |
| Authorized Official Name and Position | Zahara Williams (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4696340050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivory Park Pllc 3824 Cedar Springs Rd # 153 Dallas TX 75219-4136 Ph: () - | Ivory Park Pllc 3824 Cedar Springs Rd # 153 Dallas TX 75219-4136 Ph: (469) 634-0050 |
| NPI Number | 1073191755 |
|---|---|
| Provider Enumeration Date | 04/01/2021 |
| Last Update Date | 04/01/2021 |
| Certification Date | 03/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073191755 | NPI | - | NPPES |
| 1548406689 | Medicaid | GA | |
| 1639461106 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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