Provider Demographics
NPI:1720528524
Name:TLC
Entity type:Organization
Organization Name:TLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:COOLEY-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD ED
Authorized Official - Phone:682-622-1095
Mailing Address - Street 1:8425 HORNBEAM DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-5047
Mailing Address - Country:US
Mailing Address - Phone:817-919-2378
Mailing Address - Fax:
Practice Address - Street 1:8425 HORNBEAM DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-5047
Practice Address - Country:US
Practice Address - Phone:817-919-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health