| Phoenix Project | |
|
201 S Tyler St Dallas TX 75208-4934 | |
| (214) 942-5166 | |
| (214) 942-6006 |
| Full Name | Phoenix Project |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 201 S Tyler St, Dallas, Texas |
| Authorized Official Name and Position | Israel Pena (PROGRAM DIRECTOR) |
| Authorized Official Contact | 2149425166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Project 201 S Tyler St Dallas TX 75208-4934 Ph: (214) 942-5166 | Phoenix Project 201 S Tyler St Dallas TX 75208-4934 Ph: (214) 942-5166 |
| NPI Number | 1194889774 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194889774 | NPI | - | NPPES |
| 126830TX | Other | TX | VALUEOPTIONS NORTHSTAR # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2426-A (Texas) | Primary |
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