Provider Demographics
NPI:1669658068
Name:THE GLADNEY CENTER FOR ADOPTION
Entity Type:Organization
Organization Name:THE GLADNEY CENTER FOR ADOPTION
Other - Org Name:GLADNEY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-922-6000
Mailing Address - Street 1:6300 JOHN RYAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4122
Mailing Address - Country:US
Mailing Address - Phone:817-922-6000
Mailing Address - Fax:817-922-5955
Practice Address - Street 1:6300 JOHN RYAN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4122
Practice Address - Country:US
Practice Address - Phone:817-922-6000
Practice Address - Fax:817-922-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X, 104100000X, 1041C0700X
TXTXH7617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121712701Medicaid
TX89330SOtherBLUE CROSS BLUE SHIELD
TX89331SOtherBLUE CROSS BLUE SHIELD
TX122222602Medicaid
TX121712705Medicaid
TXTXH7617OtherSTATE LICENSE
TXTXK0154OtherSTATE LICENSE
TX122222602Medicaid
TXTXK0154OtherSTATE LICENSE
TXF71880Medicare UPIN
TX89440KMedicare PIN
TX89442KMedicare PIN