Provider Demographics
NPI:1851654735
Name:KIDS CAN FLY FOUNDATION
Entity Type:Organization
Organization Name:KIDS CAN FLY FOUNDATION
Other - Org Name:RIVERSON HOUSE, HALLIE HOUSE, PINE MOUNTAIN RANCH, KCF COUNSELING CENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:817-807-5932
Mailing Address - Street 1:1101 CRAZY HORSE TRL
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7845
Mailing Address - Country:US
Mailing Address - Phone:817-807-5932
Mailing Address - Fax:972-377-6091
Practice Address - Street 1:1201 W NORTH CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-8102
Practice Address - Country:US
Practice Address - Phone:817-807-5932
Practice Address - Fax:972-377-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 959101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
TXLMFT 469106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty