Provider Demographics
NPI:1972652600
Name:ADOLESCENT HEALTH ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ADOLESCENT HEALTH ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-239-9252
Mailing Address - Street 1:12800 HILLCREST RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1524
Mailing Address - Country:US
Mailing Address - Phone:972-239-9252
Mailing Address - Fax:972-404-9609
Practice Address - Street 1:12800 HILLCREST RD
Practice Address - Street 2:SUITE 216
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1524
Practice Address - Country:US
Practice Address - Phone:972-239-9252
Practice Address - Fax:972-404-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty