Provider Demographics
NPI:1497126163
Name:CENTERPOINTE BEHAVIORAL HEALTH DALLAS LLC
Entity Type:Organization
Organization Name:CENTERPOINTE BEHAVIORAL HEALTH DALLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHD
Authorized Official - Middle Name:AZFAR
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:636-441-7300
Mailing Address - Street 1:763 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8704
Mailing Address - Country:US
Mailing Address - Phone:314-393-3954
Mailing Address - Fax:636-447-6001
Practice Address - Street 1:3801 WILLIAM D TATE AVE
Practice Address - Street 2:SUITE 800 A
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8755
Practice Address - Country:US
Practice Address - Phone:314-393-3954
Practice Address - Fax:636-447-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health