Organization
PROVIDENCE SERVICE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD WALLACE LCSW (STATE EXECUTIVE DIRECTOR)
(512) 343-8606
Entity
Organization
Contact information
Practice address
2211 E MISSOURI AVE, E243, EL PASO, TX 79903-3807
(915) 545-8137
(915) 838-1772
Mailing address
2211 E MISSOURI AVE, E243, EL PASO, TX 79903-3807
(915) 545-8137
(915) 838-1772
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
11/10/2008
Last updated
11/10/2008
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