Provider Demographics
NPI:1558649996
Name:FIRST STEP DENTON COUNTY OUTREACH PROGRAM
Entity Type:Organization
Organization Name:FIRST STEP DENTON COUNTY OUTREACH PROGRAM
Other - Org Name:FSOP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CULBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-484-7837
Mailing Address - Street 1:1310 TEASLEY LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7946
Mailing Address - Country:US
Mailing Address - Phone:940-484-7837
Mailing Address - Fax:940-484-7835
Practice Address - Street 1:1310 TEASLEY LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7946
Practice Address - Country:US
Practice Address - Phone:940-484-7837
Practice Address - Fax:940-484-7835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16645261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000000000Medicaid