Provider Demographics
NPI:1932256260
Name:GRAPEVINE BEHAVIORAL HEALTHCARE ASSOCIATES INC
Entity Type:Organization
Organization Name:GRAPEVINE BEHAVIORAL HEALTHCARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-481-7474
Mailing Address - Street 1:2311 MUSTANG DR.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-481-7474
Mailing Address - Fax:817-416-0900
Practice Address - Street 1:2311 MUSTANG DR.
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-481-7474
Practice Address - Fax:817-416-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17295103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty