Provider Demographics
NPI:1659336345
Name:CHILD AND FAMILY GUIDANCE CENTER OF TEXOMA
Entity Type:Organization
Organization Name:CHILD AND FAMILY GUIDANCE CENTER OF TEXOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:903-893-7768
Mailing Address - Street 1:804 PECAN GROVE RD E
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1767
Mailing Address - Country:US
Mailing Address - Phone:903-893-7768
Mailing Address - Fax:903-893-4979
Practice Address - Street 1:804 PECAN GROVE RD E
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1767
Practice Address - Country:US
Practice Address - Phone:903-893-7768
Practice Address - Fax:903-893-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14846101YM0800X
TX17819101YM0800X
TX18459101YM0800X
TX901101YM0800X
TX16486101YM0800X
TX17384101YM0800X
TX18185101YM0800X
TX276931041C0700X
TX115881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82844LOtherINDIVIDUAL BCBS NUMBER
TX83590LOtherINDIVIDUAL BCBS NUMBER
TX084154602Medicaid
TX5390719OtherINDIVIDUAL AETNA NUMBER
TX00N35NOtherBCBS GROUP NUMBER
TX83343LOtherINDIVIDUAL BCBS NUMBER
TX87190QOtherINDIVIDUAL BCBS NUMBER
TX84347LOtherINDIVIDUAL BCBS NUMBER
TX084154601Medicaid