Provider Demographics
NPI:1750655833
Name:INNOVATIONS COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:INNOVATIONS COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:STILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-0444
Mailing Address - Street 1:8625 KING GEORGE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2215
Mailing Address - Country:US
Mailing Address - Phone:214-379-0444
Mailing Address - Fax:
Practice Address - Street 1:8625 KING GEORGE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2215
Practice Address - Country:US
Practice Address - Phone:214-379-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)