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On Epiphany Lane, Llc
Multi-Specialty Clinic/Center in Dallas, Texas
NPI 1891396313

On Epiphany Lane, Llc is a Multi-Specialty Clinic/Center based in Dallas, TX and is specialized in Multi-Specialty. On Epiphany Lane, Llc practices in Dallas, TX. The NPI Number for On Epiphany Lane, Llc is 1891396313 and holds a License No. (Texas).

The current practice location address for On Epiphany Lane, Llc is 603 Munger Ave Ste 100, Dallas, TX and can be reached out via phone at 214-560-0304.

Location: 603 Munger Ave Ste 100, Dallas, TX, 75202-1839
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1891396313
Provider Name
On Epiphany Lane, Llc
Credential
Provider Entity Type
Organization
Address
603 Munger Ave Ste 100, Dallas, TX, 75202-1839
Phone Number
214-560-0304
Fax Number
Provider Enumeration Date
11/02/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1215272737 01 TX NPI
institution
Provider Business Practice Location Address Details
Address
603 Munger Ave Ste 100
City
Dallas
State
Texas
Zip
75202-1840
Phone Number
214-560-0304
Fax Number
person
Provider Business Mailing Address Details
Address
603 Munger Ave Ste 100
City
Dallas
State
Texas
Zip
75202-1840
Phone Number
214-560-0304
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Agencies
Classification
Public Health or Welfare
Speciality
-
Taxonomy
251K00000X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 4
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
261QM0801X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 5
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Multi-Specialty
Taxonomy
261QM1300X
License No.
()
Definition
Definition to come...
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