Organization
I360 LIFE DEVELOPMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DESI JENSEN (OFFICE ADMINISTRATOR)
(469) 422-1262
Entity
Organization
Contact information
Practice address
6600 LBJ FWY STE 240, DALLAS, TX 75240-6550
(214) 533-5640
Mailing address
6600 LBJ FWY STE 240, DALLAS, TX 75240-6550
(214) 533-5640
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
02/18/2019
Last updated
02/18/2019
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