| Innovation 360 | |
|
6600 Lbj Fwy Suite 240 Dallas TX 75240-6514 | |
| (626) 427-2477 | |
| (626) 427-2477 |
| Full Name | Innovation 360 |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 6600 Lbj Fwy, Dallas, Texas |
| Authorized Official Name and Position | Kevin Gilliland (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6264272477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovation 360 6600 Lbj Fwy Suite 240 Dallas TX 75240-6514 Ph: (626) 427-2477 | Innovation 360 6600 Lbj Fwy Suite 240 Dallas TX 75240-6514 Ph: (626) 427-2477 |
| NPI Number | 1225425705 |
|---|---|
| Provider Enumeration Date | 04/22/2015 |
| Last Update Date | 04/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225425705 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (Texas) | Primary |
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