Organization
PROTOSTAR LLC
Active
Organization
PROTOSTAR LLC
Active
Other names
Servant's Heart Behavioral Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN KIPPES (CEO)
(214) 289-4933
Entity
Organization
Contact information
Practice address
2080 N STATE HIGHWAY 360 STE 230, GRAND PRAIRIE, TX 75050-0900
(682) 888-1290
(940) 312-7805
Mailing address
2080 N STATE HIGHWAY 360 STE 230, GRAND PRAIRIE, TX 75050-0900
(214) 289-4933
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
01/23/2019
Last updated
01/23/2019
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