Provider Demographics
NPI:1225762701
Name:HOMAGE BEHAVIORAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:HOMAGE BEHAVIORAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:817-323-7633
Mailing Address - Street 1:110 W RANDOL MILL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4613
Mailing Address - Country:US
Mailing Address - Phone:817-323-7633
Mailing Address - Fax:682-222-7574
Practice Address - Street 1:410 NW 11TH ST # 107
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5416
Practice Address - Country:US
Practice Address - Phone:817-231-0913
Practice Address - Fax:888-322-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty