Provider Demographics
NPI:1740504836
Name:T.E.A.M., INC
Entity type:Organization
Organization Name:T.E.A.M., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEXAS SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAXON
Authorized Official - Suffix:III
Authorized Official - Credentials:LBSW
Authorized Official - Phone:972-289-0040
Mailing Address - Street 1:609 N EBRITE ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3478
Mailing Address - Country:US
Mailing Address - Phone:972-289-0040
Mailing Address - Fax:972-289-0042
Practice Address - Street 1:609 N EBRITE ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3478
Practice Address - Country:US
Practice Address - Phone:972-289-0040
Practice Address - Fax:972-289-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22799104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty