Innovative Lifeskills Training Center LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

7317 Issued in TX

Legal business name

INNOVATIVE LIFESKILLS TRAINING CENTER LLC

Practice address

5001 Spring Valley
Towers East Ste 400
Dallas, TX 75244

Phone

(214) 448-3753

NPI assigned

Jun 23, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carl Robinson, PH.D.

Title

Ceo

Phone

(214) 271-0062

Specialties & licenses 2

Addresses

Other names 1

• Greater Dallas Lifeskills Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1881045680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 SPRING VALLEY",
            "address_2": "TOWERS EAST STE 400",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443946",
            "telephone_number": "214-448-3763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 SPRING VALLEY",
            "address_2": "TOWERS EAST STE 400",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75244",
            "telephone_number": "214-448-3753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE LIFESKILLS TRAINING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-271-0062",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "TX",
            "license": "7317",
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "TX",
            "license": "7317",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Dallas Lifeskills",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Health Maintenance Organization in Dallas, TX
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• Health Maintenance Organization in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.