Organization
LAUNCHABILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICE ROBINSON (CREDENTIALING COORDINATOR)
(469) 385-7687
Entity
Organization
Contact information
Practice address
4350 SIGMA RD STE 100, DALLAS, TX 75244-4421
(972) 991-6777
Mailing address
4350 SIGMA RD STE 100, DALLAS, TX 75244-4421
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
115602
TX
Other
Enumeration date
12/20/2013
Last updated
12/20/2013
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