Provider Demographics
NPI:1326292087
Name:CUMBERLAND PRESBYTERIAN CHILDREN'S HOME
Entity Type:Organization
Organization Name:CUMBERLAND PRESBYTERIAN CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:940-382-5112
Mailing Address - Street 1:1304 BERNARD ST.
Mailing Address - Street 2:P.O. DRAWER G
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-1687
Mailing Address - Country:US
Mailing Address - Phone:940-382-5112
Mailing Address - Fax:940-387-0821
Practice Address - Street 1:1304 BERNARD ST.
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76202
Practice Address - Country:US
Practice Address - Phone:940-382-5112
Practice Address - Fax:940-387-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15780101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty