Provider Demographics
NPI:1538464151
Name:SUNDANCE BEHAVIORAL HEALTH CARE, INC
Entity Type:Organization
Organization Name:SUNDANCE BEHAVIORAL HEALTH CARE, INC
Other - Org Name:SUNDANCE BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PADMANABHA
Authorized Official - Middle Name:RAJU
Authorized Official - Last Name:INDUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-222-9007
Mailing Address - Street 1:7000 HWY 287
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001
Mailing Address - Country:US
Mailing Address - Phone:817-583-8080
Mailing Address - Fax:817-483-1572
Practice Address - Street 1:7000 HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-2805
Practice Address - Country:US
Practice Address - Phone:817-222-9191
Practice Address - Fax:817-222-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty