Provider Demographics
NPI:1366865370
Name:DOGWOOD MENTAL HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:DOGWOOD MENTAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HASKELL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:936-622-0993
Mailing Address - Street 1:PO BOX 632279
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2279
Mailing Address - Country:US
Mailing Address - Phone:936-622-0993
Mailing Address - Fax:936-622-0994
Practice Address - Street 1:412 NORTH ST
Practice Address - Street 2:SUITE B
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5077
Practice Address - Country:US
Practice Address - Phone:936-622-0993
Practice Address - Fax:936-622-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty