Organization
GIFTED SOULS MENTAL HEALTH COMMUNITY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE MAYO (OWNER)
(469) 510-4291
Entity
Organization
Contact information
Practice address
17480 DALLAS PKWY STE 213, DALLAS, TX 75287-7304
(469) 510-4291
Mailing address
17480 DALLAS PKWY STE 213, DALLAS, TX 75287-7304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/19/2021
Last updated
08/22/2024
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