Provider Demographics
NPI:1043972599
Name:EFFECTIVE THERAPY COMMUNITY SUPPORT SERVICES LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:EFFECTIVE THERAPY COMMUNITY SUPPORT SERVICES LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-493-2313
Mailing Address - Street 1:212 BURBERRY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0033
Mailing Address - Country:US
Mailing Address - Phone:214-493-2313
Mailing Address - Fax:
Practice Address - Street 1:2300 VALLEY VIEW LN STE 725
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5299
Practice Address - Country:US
Practice Address - Phone:214-493-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness