Provider Demographics
NPI:1457916041
Name:RESOURCE CENTER LGBTQ HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:RESOURCE CENTER LGBTQ HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-521-5124
Mailing Address - Street 1:5750 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6802
Mailing Address - Country:US
Mailing Address - Phone:214-521-5124
Mailing Address - Fax:214-522-4604
Practice Address - Street 1:2701 REAGAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3403
Practice Address - Country:US
Practice Address - Phone:214-540-4492
Practice Address - Fax:214-261-2318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESOURCE CENTER OF DALLAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-08
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty