Organization
LAKES REGIONAL MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN DELANEY (EXECUTIVE DIRECTOR)
(972) 524-4159
Entity
Organization
Contact information
Practice address
4804 WESLEY ST, GREENVILLE, TX 75401-5650
(903) 454-0300
(903) 454-8635
Mailing address
400 AIRPORT RD, TERRELL, TX 75160-4302
(972) 524-4159
(972) 563-0292
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
103098
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103098
PROFESSIONAL LICENSE NUMB
TX
Enumeration date
02/11/2008
Last updated
02/11/2008
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