Provider Demographics
NPI:1568764827
Name:ELLIS COUNTY CHILDREN'S ADVOCACY CENTER
Entity Type:Organization
Organization Name:ELLIS COUNTY CHILDREN'S ADVOCACY CENTER
Other - Org Name:THE GINGERBREAD HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:972-937-1870
Mailing Address - Street 1:425 E ROSS ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2636
Mailing Address - Country:US
Mailing Address - Phone:972-937-1870
Mailing Address - Fax:972-937-1891
Practice Address - Street 1:425 E ROSS ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2636
Practice Address - Country:US
Practice Address - Phone:972-937-1870
Practice Address - Fax:972-937-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX64649251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty