Provider Demographics
NPI:1053667436
Name:DEEP EAST TEXAS DEVELOPMENT COUNCIL
Entity Type:Organization
Organization Name:DEEP EAST TEXAS DEVELOPMENT COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIGGLES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:409-384-5704
Mailing Address - Street 1:210 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-7495
Mailing Address - Country:US
Mailing Address - Phone:409-384-5704
Mailing Address - Fax:409-384-5390
Practice Address - Street 1:210 PREMIER DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-7495
Practice Address - Country:US
Practice Address - Phone:409-384-5704
Practice Address - Fax:409-384-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management