| Legal Business Name | |
|
120 Independence Dr Joshua TX 76058-4645 | |
| (903) 237-9689 | |
| Not Available |
| Full Name | Legal Business Name |
|---|---|
| Speciality | Counselor - Professional |
| Location | 120 Independence Dr, Joshua, Texas |
| Authorized Official Name and Position | Nicholas Jay Simmons (COUNSELOR) |
| Authorized Official Contact | 9032379689 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legal Business Name 120 Independence Dr Joshua TX 76058-4645 Ph: (903) 237-9689 | Legal Business Name 120 Independence Dr Joshua TX 76058-4645 Ph: (903) 237-9689 |
| NPI Number | 1669200804 |
|---|---|
| Provider Enumeration Date | 07/22/2024 |
| Last Update Date | 07/22/2024 |
| Certification Date | 07/21/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669200804 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Community Autism Intervention Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 Mockingbird Hill Dr, Joshua, TX 76058 Phone: 520-456-7071 |