Organization
WEST TEXAS CHILD DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT MICHAEL INGRAM M.ED, BCBA (OWENR)
(325) 320-3204
Entity
Organization
Contact information
Practice address
2032 W HARRIS AVE, SAN ANGELO, TX 76901-3806
(325) 320-3204
Mailing address
2032 W HARRIS AVE, SAN ANGELO, TX 76901-3806
(325) 320-3204
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
1-13-14897
TX
251S00000X
Community/Behavioral Health Agency
—
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Other
Enumeration date
05/05/2014
Last updated
05/05/2014
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