Provider Demographics
NPI:1699830315
Name:SOUTHWEST BEHAVIORAL SYSTEMS INC
Entity Type:Organization
Organization Name:SOUTHWEST BEHAVIORAL SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GOSBY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:JR
Authorized Official - Credentials:EDD
Authorized Official - Phone:214-489-9300
Mailing Address - Street 1:3827 S BUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-4312
Mailing Address - Country:US
Mailing Address - Phone:214-489-9300
Mailing Address - Fax:214-489-9301
Practice Address - Street 1:3827 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-4312
Practice Address - Country:US
Practice Address - Phone:214-489-9300
Practice Address - Fax:214-489-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
TX1944-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0655029Medicaid