Provider Demographics
NPI:1205382918
Name:JAFA GROUP, INC.
Entity Type:Organization
Organization Name:JAFA GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-721-8074
Mailing Address - Street 1:1441 PALMNILD CIRCLE WEST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-4707
Mailing Address - Country:US
Mailing Address - Phone:817-721-8074
Mailing Address - Fax:817-277-1144
Practice Address - Street 1:110 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4611
Practice Address - Country:US
Practice Address - Phone:817-721-8074
Practice Address - Fax:817-277-1144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES A. FARMER PHD.,LCSW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX064220901Medicaid
TX00S74SMedicare PIN