Provider Demographics
NPI:1154912400
Name:HEROIC LOVE INC
Entity type:Organization
Organization Name:HEROIC LOVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-236-8567
Mailing Address - Street 1:539 W COMMERCE ST STE 1113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:214-236-8567
Mailing Address - Fax:
Practice Address - Street 1:825 CANYON PL
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6372
Practice Address - Country:US
Practice Address - Phone:214-236-8567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359047301Medicaid