Provider Demographics
NPI:1275733446
Name:FEDERAL CORRECTIONAL INSTITUTION
Entity Type:Organization
Organization Name:FEDERAL CORRECTIONAL INSTITUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:817-413-3013
Mailing Address - Street 1:3150 HORTON RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76119-5905
Mailing Address - Country:US
Mailing Address - Phone:817-413-3274
Mailing Address - Fax:817-413-3295
Practice Address - Street 1:3150 HORTON RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-5905
Practice Address - Country:US
Practice Address - Phone:817-413-3274
Practice Address - Fax:817-413-3295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF JUSTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1981251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health