Provider Demographics
NPI:1619203361
Name:GREATER SOUTHWEST GROUP CORPORATION
Entity Type:Organization
Organization Name:GREATER SOUTHWEST GROUP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-955-2879
Mailing Address - Street 1:316 W BELT LINE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2049
Mailing Address - Country:US
Mailing Address - Phone:972-955-2879
Mailing Address - Fax:972-293-9183
Practice Address - Street 1:316 W BELT LINE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2049
Practice Address - Country:US
Practice Address - Phone:972-955-2879
Practice Address - Fax:972-293-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18630103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty