Provider Demographics
NPI:1275153793
Name:NORTH TEXAS BEHAVIORAL HEALTH AUTHORITY
Entity Type:Organization
Organization Name:NORTH TEXAS BEHAVIORAL HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALATICH-LUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-299-9373
Mailing Address - Street 1:9441 LYNDON B JOHNSON FWY STE 350
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4652
Mailing Address - Country:US
Mailing Address - Phone:469-523-0521
Mailing Address - Fax:
Practice Address - Street 1:3001 AL LIPSCOMB WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-1702
Practice Address - Country:US
Practice Address - Phone:214-366-9407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management