Provider Demographics
NPI:1215198072
Name:SIMPLY T&T
Entity Type:Organization
Organization Name:SIMPLY T&T
Other - Org Name:LOGOS HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MOBOLAJI
Authorized Official - Middle Name:ADENIKE
Authorized Official - Last Name:IKUJENYO
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:214-636-1092
Mailing Address - Street 1:528 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3423
Mailing Address - Country:US
Mailing Address - Phone:214-636-1092
Mailing Address - Fax:972-234-5665
Practice Address - Street 1:528 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3423
Practice Address - Country:US
Practice Address - Phone:214-636-1092
Practice Address - Fax:972-234-5665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320800000X320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness