Provider Demographics
NPI:1952542813
Name:TEXAS HEALTH
Entity type:Organization
Organization Name:TEXAS HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LPC, CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHART
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CRC,LPC#15980
Authorized Official - Phone:214-692-6666
Mailing Address - Street 1:5445 LA SIERRA DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4139
Mailing Address - Country:US
Mailing Address - Phone:214-692-6666
Mailing Address - Fax:214-692-6670
Practice Address - Street 1:185 EASTGATE PLZ
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2868
Practice Address - Country:US
Practice Address - Phone:254-412-2667
Practice Address - Fax:254-799-5768
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63195302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization