Provider Demographics
NPI:1073064218
Name:EATING RECOVERY CENTER OF TEXAS
Entity Type:Organization
Organization Name:EATING RECOVERY CENTER OF TEXAS
Other - Org Name:EATING RECOVERY CENTER OF DALLAS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-476-0812
Mailing Address - Street 1:PO BOX 561485
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0001
Mailing Address - Country:US
Mailing Address - Phone:877-825-8584
Mailing Address - Fax:
Practice Address - Street 1:4716 ALLIANCE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5303
Practice Address - Country:US
Practice Address - Phone:877-825-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center