Provider Demographics
NPI:1235367384
Name:NEW DESTINATIONS
Entity Type:Organization
Organization Name:NEW DESTINATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LOT
Authorized Official - Phone:903-692-3463
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-7515
Mailing Address - Country:US
Mailing Address - Phone:936-248-2322
Mailing Address - Fax:
Practice Address - Street 1:649 COUNTY ROAD 433
Practice Address - Street 2:
Practice Address - City:TENAHA
Practice Address - State:TX
Practice Address - Zip Code:75974-6332
Practice Address - Country:US
Practice Address - Phone:936-248-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20345101YP2500X
TX106894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty