1568096857 NPI number — AJM CLINICAL THERAPY & CONSULTING, PLLC

Table of content: (NPI 1568096857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568096857 NPI number — AJM CLINICAL THERAPY & CONSULTING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AJM CLINICAL THERAPY & CONSULTING, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1568096857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2750 CLEAR LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76065-6251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-765-2014
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1666 N HAMPTON RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-2390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-677-8382
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
JONES-MCCRACKEN
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
817-677-8382

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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