Provider Demographics
NPI:1467146696
Name:MENTORING INDIVIDUALS NEEDING OFFENDER RE-ENTRY SUPPORT
Entity Type:Organization
Organization Name:MENTORING INDIVIDUALS NEEDING OFFENDER RE-ENTRY SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:972-513-3819
Mailing Address - Street 1:4346 W NORTHGATE DR APT 199
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2584
Mailing Address - Country:US
Mailing Address - Phone:972-513-3819
Mailing Address - Fax:
Practice Address - Street 1:4346 W NORTHGATE DR APT 199
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2584
Practice Address - Country:US
Practice Address - Phone:972-513-3819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty