Provider Demographics
NPI:1053848093
Name:ARLINGTON DEPRESSION TREATMENT CENTER
Entity type:Organization
Organization Name:ARLINGTON DEPRESSION TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-200-6715
Mailing Address - Street 1:801 ROAD TO SIX FLAGS W STE 124
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2615
Mailing Address - Country:US
Mailing Address - Phone:817-200-6715
Mailing Address - Fax:817-200-6907
Practice Address - Street 1:801 ROAD TO SIX FLAGS W STE 124
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2615
Practice Address - Country:US
Practice Address - Phone:817-200-6715
Practice Address - Fax:817-200-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty