Provider Demographics
NPI:1104684000
Name:APPLIED GROWTH BEHAVIORAL HEALTH SERVICE LLC
Entity type:Organization
Organization Name:APPLIED GROWTH BEHAVIORAL HEALTH SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HASIM
Authorized Official - Middle Name:AKEEM
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-655-6892
Mailing Address - Street 1:2302 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5900
Mailing Address - Country:US
Mailing Address - Phone:318-655-6892
Mailing Address - Fax:
Practice Address - Street 1:2302 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5900
Practice Address - Country:US
Practice Address - Phone:318-655-6892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)