Provider Demographics
NPI:1699021089
Name:METROCARE
Entity Type:Organization
Organization Name:METROCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER III
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAZANE
Authorized Official - Middle Name:SHERILYN
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC, ADC-III,
Authorized Official - Phone:972-861-5917
Mailing Address - Street 1:3330 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-4531
Mailing Address - Country:US
Mailing Address - Phone:214-371-0474
Mailing Address - Fax:214-371-3933
Practice Address - Street 1:3330 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4531
Practice Address - Country:US
Practice Address - Phone:214-371-0474
Practice Address - Fax:214-371-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15910251S00000X
TX8802251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0291080-03Medicaid