Provider Demographics
NPI:1225648223
Name:MENTAL RESILIENT SERVICES
Entity Type:Organization
Organization Name:MENTAL RESILIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NYKITIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:469-844-7011
Mailing Address - Street 1:2351 W NORTHWEST HWY STE 1302
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-8430
Mailing Address - Country:US
Mailing Address - Phone:469-844-7011
Mailing Address - Fax:469-914-9624
Practice Address - Street 1:2351 W NORTHWEST HWY STE 1302
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-8430
Practice Address - Country:US
Practice Address - Phone:469-844-7011
Practice Address - Fax:469-914-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty