Organization
SOUTHERN AREA BEHAVIORAL HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH R MEDLOCK (CHIEF EXECUTIVE OFFICER)
(972) 283-9090
Entity
Organization
Contact information
Practice address
4215 GANNON LN, DALLAS, TX 75237-2914
(972) 283-9090
(972) 499-0367
Mailing address
4215 GANNON LN, DALLAS, TX 75237-2914
(972) 283-9090
(972) 499-0367
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
06/24/2009
Last updated
01/03/2024
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