Organization
IDT ENTERPRISE LLC
Active
Other names
Success on the Spectrum
Organization subpart
No
Provider details
NPI number
Authorized official
TELEMA NGA (CEO)
(682) 201-7934
Entity
Organization
Contact information
Practice address
1510 N HAMPTON RD STE 150, DESOTO, TX 75115-8324
(682) 201-7934
Mailing address
1106 CORDOVA ST, MANSFIELD, TX 76063-3198
(682) 201-7934
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
07/04/2023
Last updated
10/31/2023
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