Provider Demographics
NPI:1013405570
Name:ST ANTHONYS HOUSE
Entity Type:Organization
Organization Name:ST ANTHONYS HOUSE
Other - Org Name:TEXAS FAMILY SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JURGELA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-678-3317
Mailing Address - Street 1:1713 QUARRY LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5080
Mailing Address - Country:US
Mailing Address - Phone:801-678-3317
Mailing Address - Fax:
Practice Address - Street 1:1713 QUARRY LN
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5080
Practice Address - Country:US
Practice Address - Phone:801-678-3317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3774622-01Medicaid