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Organization
GIFTED SOULS MENTAL HEALTH COMMUNITY CENTER LLC
Active
Organization
GIFTED SOULS MENTAL HEALTH COMMUNITY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE MAYO (OWNER)
(469) 510-4291
Entity
Organization
Contact information
Practice address
17480 DALLAS PKWY STE 213, DALLAS, TX 75287-7304
(469) 510-4291
Mailing address
17480 DALLAS PKWY STE 213, DALLAS, TX 75287-7304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
01/19/2021
Last updated
08/22/2024
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