Provider Demographics
NPI:1285451336
Name:BEHAVIORAL MEDICINE CLINIC
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-957-6270
Mailing Address - Street 1:6750 HILLCREST PLAZA DR STE 214
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1436
Mailing Address - Country:US
Mailing Address - Phone:214-957-6270
Mailing Address - Fax:972-458-0081
Practice Address - Street 1:6750 HILLCREST PLAZA DR STE 214
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1436
Practice Address - Country:US
Practice Address - Phone:214-957-6270
Practice Address - Fax:972-458-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty