Provider Demographics
NPI:1437349859
Name:MY HEALTH MY RESOURCES OF TARRANT COUNTY
Entity Type:Organization
Organization Name:MY HEALTH MY RESOURCES OF TARRANT COUNTY
Other - Org Name:LPC MEDICAID GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:ENROLLMENT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-569-5235
Mailing Address - Street 1:PO BOX 2603
Mailing Address - Street 2:HTN, CLIENT ACCOUNTING
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2603
Mailing Address - Country:US
Mailing Address - Phone:817-569-4395
Mailing Address - Fax:817-569-4517
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:HTN, CLIENT ACCOUNTING
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-569-4395
Practice Address - Fax:817-569-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135082908Medicaid