Provider Demographics
NPI:1578189940
Name:YOUR DISCOVERY PLACE INC
Entity Type:Organization
Organization Name:YOUR DISCOVERY PLACE INC
Other - Org Name:YOUR DISCOVERY PLACE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHEVELLA
Authorized Official - Middle Name:JOYNELL
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:469-251-9201
Mailing Address - Street 1:3911 S LANCASTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-5682
Mailing Address - Country:US
Mailing Address - Phone:855-207-0596
Mailing Address - Fax:
Practice Address - Street 1:3911 S LANCASTER RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5682
Practice Address - Country:US
Practice Address - Phone:855-207-0596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit