Provider Demographics
NPI:1629523311
Name:TLC ENTERPRISE
Entity Type:Organization
Organization Name:TLC ENTERPRISE
Other - Org Name:TONDALA LATRECE COMPANY ENTERPRISE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CERTIFIEDANGER MANGEMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TONDALA
Authorized Official - Middle Name:LATECE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CAMS
Authorized Official - Phone:214-305-6910
Mailing Address - Street 1:8811 TEEL PKWY
Mailing Address - Street 2:SUITE 100-5222
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-4201
Mailing Address - Country:US
Mailing Address - Phone:214-305-6910
Mailing Address - Fax:214-305-6910
Practice Address - Street 1:8811 TEEL PKWY
Practice Address - Street 2:SUITE 100-5222
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4201
Practice Address - Country:US
Practice Address - Phone:214-305-6910
Practice Address - Fax:214-305-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCERTIFIED103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty