Provider Demographics
NPI:1760522411
Name:INSTITUTE OF COGNTIVE DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:INSTITUTE OF COGNTIVE DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-658-8631
Mailing Address - Street 1:PO BOX 5018
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-5018
Mailing Address - Country:US
Mailing Address - Phone:325-658-8631
Mailing Address - Fax:325-659-2070
Practice Address - Street 1:79 GILLIS ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5819
Practice Address - Country:US
Practice Address - Phone:325-658-8631
Practice Address - Fax:325-659-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X251S00000X
TX320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities