Provider Demographics
NPI:1801421938
Name:DFW DIAGNOSTIC CENTER
Entity type:Organization
Organization Name:DFW DIAGNOSTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:KTEILY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPCS
Authorized Official - Phone:972-304-0700
Mailing Address - Street 1:270 N DENTON TAP RD STE 160
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2133
Mailing Address - Country:US
Mailing Address - Phone:972-304-0700
Mailing Address - Fax:972-692-5844
Practice Address - Street 1:270 N DENTON TAP RD STE 160
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2133
Practice Address - Country:US
Practice Address - Phone:972-304-0700
Practice Address - Fax:972-692-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty