Provider Demographics
NPI:1952081911
Name:EATING RECOVERY CENTER OF TEXAS
Entity Type:Organization
Organization Name:EATING RECOVERY CENTER OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-383-4781
Mailing Address - Street 1:7351 E LOWRY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 SOUTH UNIVERSITY DRIVE JARVIS HALL STE 232
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76129-0001
Practice Address - Country:US
Practice Address - Phone:877-825-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EATING RECOVERY CENTER OF TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-24
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty