1740695915 NPI number — NORTH TEXAS BEHAVIORAL CLINIC LLC

Table of content: (NPI 1740695915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740695915 NPI number — NORTH TEXAS BEHAVIORAL CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS BEHAVIORAL CLINIC LLC
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740695915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 N FIELDER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76012-4695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-962-0409
Provider Business Mailing Address Fax Number:
817-200-6743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 N FIELDER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-4695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-962-0409
Provider Business Practice Location Address Fax Number:
817-200-6743
Provider Enumeration Date:
06/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ABUOR
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
469-733-3223

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  641881 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 203955402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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