Provider Demographics
NPI:1639352552
Name:DALLAS CHILDRENS ADVOCACY CENTER
Entity Type:Organization
Organization Name:DALLAS CHILDRENS ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCI
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:214-818-2600
Mailing Address - Street 1:3611 SWISS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6245
Mailing Address - Country:US
Mailing Address - Phone:214-818-2600
Mailing Address - Fax:
Practice Address - Street 1:3611 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6245
Practice Address - Country:US
Practice Address - Phone:214-818-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2010-11-09
Deactivation Date:2008-01-09
Deactivation Code:
Reactivation Date:2010-11-09
Provider Licenses
StateLicense IDTaxonomies
TX63237251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health