Organization
DUNCANVILLE MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH R MEDLOCK (CHIEF EXECUTIVE OFFICER)
(469) 879-8328
Entity
Organization
Contact information
Practice address
4333 GANNON LN STE 101, DALLAS, TX 75237-4222
(972) 283-9090
(972) 499-0637
Mailing address
150 E HIGHWAY 67 STE 204, DUNCANVILLE, TX 75137-4481
(469) 879-8328
(469) 916-4677
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
04/21/2018
Last updated
08/17/2018
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