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640 W Southlake Blvd Southlake TX 76092-6023 | |
| (520) 624-4000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 640 W Southlake Blvd, Southlake, Texas |
| Authorized Official Name and Position | Brian Phillip Farley (VICE PRESIDENT AND SECRETARY) |
| Authorized Official Contact | 6158616000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6100 Tower Cir Ste 1000 Franklin TN 37067-1509 Ph: (615) 861-6000 | 640 W Southlake Blvd Southlake TX 76092-6023 Ph: (520) 624-4000 |
| NPI Number | 1497420673 |
|---|---|
| Provider Enumeration Date | 08/10/2021 |
| Last Update Date | 10/18/2023 |
| Certification Date | 10/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497420673 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
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