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2401 S 31st St Temple TX 76508-0001 | |
| (254) 724-2111 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2401 S 31st St, Temple, Texas |
| Authorized Official Name and Position | Alice Cantu (ASSOCIATE VICE PRESIDENT, RCO) |
| Authorized Official Contact | 2542159719 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
P.o. Box 847556 Dallas TX 75284-7556 Ph: (254) 724-2111 | 2401 S 31st St Temple TX 76508-0001 Ph: (254) 724-2111 |
| NPI Number | 1730213836 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 05/28/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730213836 | NPI | - | NPPES |
| 1778243-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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