Provider Demographics
NPI:1336546951
Name:INCREMENTUM FAMILY DEVELOPMENT CENTERS OF TX LLC
Entity Type:Organization
Organization Name:INCREMENTUM FAMILY DEVELOPMENT CENTERS OF TX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROMYA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-810-4334
Mailing Address - Street 1:215 WOOD ST APT 113
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 WOOD ST APT 113
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2122
Practice Address - Country:US
Practice Address - Phone:702-810-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802106560251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health