Provider Demographics
NPI:1356754527
Name:COUNSELING AND DIAGNOSTIC CENTER, LLC
Entity type:Organization
Organization Name:COUNSELING AND DIAGNOSTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TALMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-760-1964
Mailing Address - Street 1:16415 ADDISON RD
Mailing Address - Street 2:SUITE 640
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3218
Mailing Address - Country:US
Mailing Address - Phone:214-760-1964
Mailing Address - Fax:214-760-9505
Practice Address - Street 1:16415 ADDISON RD
Practice Address - Street 2:SUITE 640
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3218
Practice Address - Country:US
Practice Address - Phone:214-760-1964
Practice Address - Fax:214-760-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34150103TS0200X
TX64837101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty