| Specialized Transformation | |
|
2305 Corn Valley Rd 230-4b Grand Prairie TX 75051-8804 | |
| (800) 601-9519 | |
| (866) 326-6765 |
| Full Name | Specialized Transformation |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2305 Corn Valley Rd, Grand Prairie, Texas |
| Authorized Official Name and Position | Tanisha Guy (ONWERS) |
| Authorized Official Contact | 8006019519 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialized Transformation 2305 Corn Valley Rd 230-4b Grand Prairie TX 75051-8804 Ph: (800) 601-9519 | Specialized Transformation 2305 Corn Valley Rd 230-4b Grand Prairie TX 75051-8804 Ph: (800) 601-9519 |
| NPI Number | 1235495607 |
|---|---|
| Provider Enumeration Date | 04/10/2012 |
| Last Update Date | 04/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235495607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 64618 (Texas) | Primary |
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