Provider Demographics
NPI:1326202870
Name:COLLIN COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER
Entity Type:Organization
Organization Name:COLLIN COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER
Other - Org Name:LIFEPATH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-963-3655
Mailing Address - Street 1:1515 HERITAGE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3378
Mailing Address - Country:US
Mailing Address - Phone:972-562-0190
Mailing Address - Fax:972-562-3647
Practice Address - Street 1:1515 HERITAGE DR
Practice Address - Street 2:105
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3256
Practice Address - Country:US
Practice Address - Phone:972-562-0190
Practice Address - Fax:972-665-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017420301Medicaid