Organization
LAUNCHABILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHY PACKARD (CHIEF EXECUTIVE OFFICER)
(972) 991-6777
Entity
Organization
Contact information
Practice address
1701 N COLLINS BLVD, STE 100, RICHARDSON, TX 75080-3564
(469) 385-7298
(469) 385-4265
Mailing address
1701 N COLLINS BLVD, STE 100, RICHARDSON, TX 75080-3564
(469) 385-7298
(469) 385-4265
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
251B00000X
Case Management Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017439301
—
TX
Enumeration date
01/05/2007
Last updated
03/07/2013
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