Provider Demographics
NPI:1649566795
Name:SENIOR PSYCHOLOGICAL CARE DALLAS I, LLC
Entity Type:Organization
Organization Name:SENIOR PSYCHOLOGICAL CARE DALLAS I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAPART
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:713-850-0049
Mailing Address - Street 1:4635 SOUTHWEST FWY STE 635
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7112
Mailing Address - Country:US
Mailing Address - Phone:713-850-0049
Mailing Address - Fax:713-627-7302
Practice Address - Street 1:4635 SOUTHWEST FWY STE 635
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7112
Practice Address - Country:US
Practice Address - Phone:713-850-0049
Practice Address - Fax:713-627-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0012XBOtherBCBS TX
TX287992603Medicaid
TX287992601Medicaid
TX287992602Medicaid
TXDS2658OtherRR MCR HARRIS
TXDS2658OtherRR MCR HARRIS
TX287992603Medicaid
TXTXB147046Medicare PIN
TX0012XBOtherBCBS TX