Provider Demographics
NPI:1609197987
Name:MARGENTA FORUMS
Entity type:Organization
Organization Name:MARGENTA FORUMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-731-9229
Mailing Address - Street 1:1510 MICKEY MANTLE PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2452
Mailing Address - Country:US
Mailing Address - Phone:512-731-9909
Mailing Address - Fax:877-433-3010
Practice Address - Street 1:1510 MICKEY MANTLE PL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2452
Practice Address - Country:US
Practice Address - Phone:512-731-9909
Practice Address - Fax:877-433-3010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATMAN ENTERPRICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-21
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty