Provider Demographics
NPI:1215048855
Name:TEXAS FORWARD VISIONS, I. P.C.
Entity type:Organization
Organization Name:TEXAS FORWARD VISIONS, I. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LOU
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-566-2807
Mailing Address - Street 1:PO BOX 133182
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-3182
Mailing Address - Country:US
Mailing Address - Phone:903-566-2807
Mailing Address - Fax:309-566-6905
Practice Address - Street 1:1809 GISH LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5142
Practice Address - Country:US
Practice Address - Phone:903-566-2807
Practice Address - Fax:903-566-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148282001Medicaid
TX148282002Medicaid