Organization
MIDCITIES CENTER FOR CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN ALVIN BENNETT JR. LCSW, CART (PARTNER)
(817) 917-2335
Entity
Organization
Contact information
Practice address
610 S INDUSTRIAL BLVD, SUITE 307, EULESS, TX 76040-5048
(817) 917-2335
Mailing address
610 S INDUSTRIAL BLVD, SUITE 307, EULESS, TX 76040-5048
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
50547
TX
251S00000X
Community/Behavioral Health Agency
65300
TX
Other
Enumeration date
02/03/2011
Last updated
02/03/2011
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