Provider Demographics
NPI: | 1811217789 |
---|---|
Name: | FIRST STEP DENTON COUNTY OUTREACH PROGRAM |
Entity Type: | Organization |
Organization Name: | FIRST STEP DENTON COUNTY OUTREACH PROGRAM |
Other - Org Name: | ROY E. CULBERSON |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ROY |
Authorized Official - Middle Name: | EDWARD |
Authorized Official - Last Name: | CULBERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 940-484-7837 |
Mailing Address - Street 1: | 1310 TEASLEY LN |
Mailing Address - Street 2: | |
Mailing Address - City: | DENTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76205-7946 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 940-484-7837 |
Mailing Address - Fax: | 940-484-7835 |
Practice Address - Street 1: | 1310 TEASLEY LN |
Practice Address - Street 2: | |
Practice Address - City: | DENTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76205-7946 |
Practice Address - Country: | US |
Practice Address - Phone: | 940-484-7837 |
Practice Address - Fax: | 940-484-7835 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-06-02 |
Last Update Date: | 2010-06-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 3160-3161 | 101YA0400X, 101YP2500X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TP2701X, 103TR0400X, 171100000X, 251C00000X, 251E00000X, 251S00000X, 261QR0405X |
251300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
No | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty | |
No | 251300000X | Agencies | Local Education Agency (LEA) | Group - Multi-Specialty | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Multi-Specialty | |
No | 251E00000X | Agencies | Home Health | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty |