Provider Demographics
NPI:1952637076
Name:EARLY CHILDHOOD INTERVENTION
Entity Type:Organization
Organization Name:EARLY CHILDHOOD INTERVENTION
Other - Org Name:MHMR OF TARRANT COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MAUGHAN
Authorized Official - Last Name:HAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:682-429-0556
Mailing Address - Street 1:3840 HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7277
Mailing Address - Country:US
Mailing Address - Phone:682-429-0556
Mailing Address - Fax:817-569-5149
Practice Address - Street 1:5650 N RIVERSIDE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2464
Practice Address - Country:US
Practice Address - Phone:682-429-0556
Practice Address - Fax:817-569-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163W00000X252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency