Provider Demographics
NPI:1205231198
Name:ST. MARY'S II CENTER FOR EXCEPTIONAL CHILDREN,LLC
Entity Type:Organization
Organization Name:ST. MARY'S II CENTER FOR EXCEPTIONAL CHILDREN,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:POWER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:972-966-1080
Mailing Address - Street 1:2300 HIGHLAND VILLAGE RD
Mailing Address - Street 2:BUILDING 8, SUITE 810
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7148
Mailing Address - Country:US
Mailing Address - Phone:972-966-1080
Mailing Address - Fax:
Practice Address - Street 1:2300 HIGHLAND VILLAGE RD
Practice Address - Street 2:BUILDING 8, SUITE 810
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7148
Practice Address - Country:US
Practice Address - Phone:972-966-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193400000XOtherSINGLE SPECIALTY