Provider Demographics
NPI:1679704787
Name:AGAPE MIND SERVICES
Entity type:Organization
Organization Name:AGAPE MIND SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-317-7800
Mailing Address - Street 1:2820 VILLAGE PKWY STE 620
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3298
Mailing Address - Country:US
Mailing Address - Phone:972-317-7800
Mailing Address - Fax:972-317-3032
Practice Address - Street 1:2820 VILLAGE PKWY STE 620
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3298
Practice Address - Country:US
Practice Address - Phone:972-317-7800
Practice Address - Fax:972-317-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1950261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health