Provider Demographics
NPI:1598970964
Name:MERIT FAMILY SERVICES
Entity Type:Organization
Organization Name:MERIT FAMILY SERVICES
Other - Org Name:MERIT CHEMICAL DEPENDENCY PROGRAM, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-413-9463
Mailing Address - Street 1:3807 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3522
Mailing Address - Country:US
Mailing Address - Phone:817-413-9463
Mailing Address - Fax:817-413-9189
Practice Address - Street 1:3807 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3522
Practice Address - Country:US
Practice Address - Phone:817-413-9463
Practice Address - Fax:817-413-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty