Southern Area Behavioral Healthcare LLC
Psychiatry & Neurology, Psychiatry in Dallas, TX. Organization (NPI-2).
NPI number1396973772
StatusActive
Last updated in NPPESJan 3, 2024
Details
- NPI
- 1396973772
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Area Behavioral Healthcare LLC
- Organization subpart
- No
- Enumeration date
- Jun 24, 2009
- Certification date
- Jan 3, 2024
- Last updated
- Jan 3, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | – | – | Yes |
| 101YP2500X | Counselor, Professional | – | – | |
| 171M00000X | Case Manager/Care Coordinator | – | – | |
| 251B00000X | Case Management | – | – | |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | |
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – | |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – |
Practice location
4215 Gannon LnDallas, TX 75237-2914
Phone 972-283-9090 · Fax 972-499-0367
Mailing address
4215 Gannon LnDallas, TX 75237-2914
Phone 972-283-9090 · Fax 972-499-0367
Other practice locations
3001 Al Lipscomb Way
Dallas, TX 75215-1702
Dallas, TX 75215-1702
Phone 972-283-9090 · Fax 972-499-0367
110 W Grove St
Kaufman, TX 75142-2033
Kaufman, TX 75142-2033
Phone 972-283-9090 · Fax 972-499-0367
Authorized official
Kenneth R Medlock
Chief Executive Officer
9722839090
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