Provider Demographics
NPI:1063960714
Name:CHARACTER FIRST IOP LLC
Entity type:Organization
Organization Name:CHARACTER FIRST IOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMISSIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-995-9566
Mailing Address - Street 1:5115 MCKINNEY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3334
Mailing Address - Country:US
Mailing Address - Phone:214-902-9881
Mailing Address - Fax:
Practice Address - Street 1:5115 MCKINNEY AVE STE B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3334
Practice Address - Country:US
Practice Address - Phone:214-902-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty