Provider Demographics
NPI:1477909158
Name:DEPRESSION CONNECTION FOR RECOVERY
Entity Type:Organization
Organization Name:DEPRESSION CONNECTION FOR RECOVERY
Other - Org Name:DEPRESSION CONNECTION TEAM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CERTIFIED PEER SUPPORT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS
Authorized Official - Phone:817-810-9599
Mailing Address - Street 1:3212 COLLINSWORTH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6580
Mailing Address - Country:US
Mailing Address - Phone:817-810-9599
Mailing Address - Fax:
Practice Address - Street 1:3212 COLLINSWORTH ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6580
Practice Address - Country:US
Practice Address - Phone:817-810-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health