Provider Demographics
NPI:1689841751
Name:EASTER SEALS NORTH TEXAS INC.
Entity Type:Organization
Organization Name:EASTER SEALS NORTH TEXAS INC.
Other - Org Name:DFW CENTER FOR AUTISM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-759-7925
Mailing Address - Street 1:1424 HEMPHILL ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4703
Mailing Address - Country:US
Mailing Address - Phone:888-617-7171
Mailing Address - Fax:817-332-7601
Practice Address - Street 1:303 W NASH ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5512
Practice Address - Country:US
Practice Address - Phone:817-424-9797
Practice Address - Fax:817-424-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X-TAXONOMY103T00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty