Provider Demographics
NPI:1972971786
Name:BECKLOFF PEDIATRIC BEHAVIORAL CENTER
Entity Type:Organization
Organization Name:BECKLOFF PEDIATRIC BEHAVIORAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KATLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRODT
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, NCC
Authorized Official - Phone:972-672-1757
Mailing Address - Street 1:4101 CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3470
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17210 CAMPBELL RD
Practice Address - Street 2:200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-4202
Practice Address - Country:US
Practice Address - Phone:972-250-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BECKLOFF PEDIATRIC BEHAVIORAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68931251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health