Provider Demographics
NPI:1457644379
Name:CALM PROGRAM
Entity Type:Organization
Organization Name:CALM PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PURTELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:972-387-7480
Mailing Address - Street 1:15305 DALLAS PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4637
Mailing Address - Country:US
Mailing Address - Phone:972-387-7480
Mailing Address - Fax:972-387-7481
Practice Address - Street 1:15305 DALLAS PKWY
Practice Address - Street 2:STE 300
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4637
Practice Address - Country:US
Practice Address - Phone:972-387-7480
Practice Address - Fax:972-387-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63840101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty