Provider Demographics
NPI:1477167591
Name:GENESIS FACTOR INTERNATIONAL INC.
Entity Type:Organization
Organization Name:GENESIS FACTOR INTERNATIONAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER IN COUNSELING
Authorized Official - Phone:817-983-2077
Mailing Address - Street 1:6387B CAMP BOWIE BLVD # 629
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5423
Mailing Address - Country:US
Mailing Address - Phone:817-983-2077
Mailing Address - Fax:
Practice Address - Street 1:2917 BUCKSKIN RUN APT 808
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-9601
Practice Address - Country:US
Practice Address - Phone:817-983-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No385H00000XRespite Care FacilityRespite Care