Provider Demographics
NPI:1043802325
Name:DEPRECE SUPPORTIVE SERVICES, LLC
Entity Type:Organization
Organization Name:DEPRECE SUPPORTIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONTYNE
Authorized Official - Middle Name:GULLEY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFTA
Authorized Official - Phone:205-587-7040
Mailing Address - Street 1:1500 GRACE LN
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1873
Mailing Address - Country:US
Mailing Address - Phone:205-587-7040
Mailing Address - Fax:
Practice Address - Street 1:1500 GRACE LANE
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:TX
Practice Address - Zip Code:75098
Practice Address - Country:US
Practice Address - Phone:469-670-7265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)