Provider Demographics
NPI:1003555244
Name:JAKIN BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:JAKIN BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIERRA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BRIGHTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-819-1731
Mailing Address - Street 1:6714 OLD STONE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2389
Mailing Address - Country:US
Mailing Address - Phone:330-819-1731
Mailing Address - Fax:
Practice Address - Street 1:6714 OLD STONE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2389
Practice Address - Country:US
Practice Address - Phone:330-819-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health