Provider Demographics
NPI:1659558146
Name:AFFECT GROUP, INC.
Entity Type:Organization
Organization Name:AFFECT GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-520-7007
Mailing Address - Street 1:10300 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 172
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8600
Mailing Address - Country:US
Mailing Address - Phone:214-520-7007
Mailing Address - Fax:214-361-1929
Practice Address - Street 1:10300 N CENTRAL EXPY
Practice Address - Street 2:SUITE 172
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8600
Practice Address - Country:US
Practice Address - Phone:214-520-7007
Practice Address - Fax:214-361-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX354851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026482201Medicaid
TX026482201Medicaid