Organization
INNOVATIVE LIFESKILLS TRAINING CENTER LLC
Active
Other names
Greater Dallas Lifeskills
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL ROBINSON PH.D. (CEO)
(214) 271-0062
Entity
Organization
Contact information
Practice address
5001 SPRING VALLEY, TOWERS EAST STE 400, DALLAS, TX 75244
(214) 448-3753
Mailing address
5001 SPRING VALLEY, TOWERS EAST STE 400, DALLAS, TX 75244-3946
(214) 448-3763
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
7317
TX
305R00000X
Preferred Provider Organization
7317
TX
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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