Provider Demographics
NPI:1356580195
Name:CCA BEHAVIORAL HEALTH, PLLC
Entity type:Organization
Organization Name:CCA BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-946-3676
Mailing Address - Street 1:424 S CORINTH STREET RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-3418
Mailing Address - Country:US
Mailing Address - Phone:214-946-3676
Mailing Address - Fax:214-941-0579
Practice Address - Street 1:424 S CORINTH STREET RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-3418
Practice Address - Country:US
Practice Address - Phone:214-946-3676
Practice Address - Fax:214-941-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty