| Idt Enterprise Llc | |
|
1510 N Hampton Rd Ste 150 Desoto TX 75115-8324 | |
| (682) 201-7934 | |
| Not Available |
| Full Name | Idt Enterprise Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1510 N Hampton Rd Ste 150, Desoto, Texas |
| Authorized Official Name and Position | Telema Nga (CEO) |
| Authorized Official Contact | 6822017934 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idt Enterprise Llc 1106 Cordova St Mansfield TX 76063-3198 Ph: (682) 201-7934 | Idt Enterprise Llc 1510 N Hampton Rd Ste 150 Desoto TX 75115-8324 Ph: (682) 201-7934 |
| NPI Number | 1396422036 |
|---|---|
| Provider Enumeration Date | 07/04/2023 |
| Last Update Date | 10/31/2023 |
| Certification Date | 10/31/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396422036 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 261QX0100X | Clinic/center - Occupational Medicine | (* (Not Available)) | Secondary |
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