Provider Demographics
NPI:1417482969
Name:ELEVEN 150 SOLUTIONS THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ELEVEN 150 SOLUTIONS THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED MARRIAGE & FAMILY TH
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS,
Authorized Official - Phone:817-307-6446
Mailing Address - Street 1:500 GRAPEVINE HWY
Mailing Address - Street 2:215
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2782
Mailing Address - Country:US
Mailing Address - Phone:817-307-6446
Mailing Address - Fax:
Practice Address - Street 1:500 GRAPEVINE HWY
Practice Address - Street 2:215
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2782
Practice Address - Country:US
Practice Address - Phone:817-307-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty