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Organization
NEW DESTINATIONS
Active
Organization
NEW DESTINATIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRIE MAE KING LOT (PROGRAM COORDINATOR)
(903) 692-3463
Entity
Organization
Contact information
Practice address
649 COUNTY ROAD 433, TENAHA, TX 75974-6332
(936) 248-2322
Mailing address
PO BOX 1515, CARTHAGE, TX 75633-7515
(936) 248-2322
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
20345
TX
225X00000X
Occupational Therapist
Primary
106894
TX
Other
Enumeration date
06/29/2009
Last updated
07/02/2010
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