Provider Demographics
NPI:1225425705
Name:TR HEALTH GROUP
Entity Type:Organization
Organization Name:TR HEALTH GROUP
Other - Org Name:INNOVATION 360
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:626-427-2477
Mailing Address - Street 1:6600 LBJ FWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6514
Mailing Address - Country:US
Mailing Address - Phone:626-427-2477
Mailing Address - Fax:626-427-2477
Practice Address - Street 1:6600 LBJ FWY
Practice Address - Street 2:SUITE 240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6514
Practice Address - Country:US
Practice Address - Phone:626-427-2477
Practice Address - Fax:626-427-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty