Provider Demographics
NPI:1679087076
Name:GENETIC RISK CONSULTING, PA
Entity Type:Organization
Organization Name:GENETIC RISK CONSULTING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-563-7333
Mailing Address - Street 1:9430 COUNTY ROAD 4074
Mailing Address - Street 2:
Mailing Address - City:SCURRY
Mailing Address - State:TX
Mailing Address - Zip Code:75158-4730
Mailing Address - Country:US
Mailing Address - Phone:469-563-7333
Mailing Address - Fax:214-481-7238
Practice Address - Street 1:9430 COUNTY ROAD 4074
Practice Address - Street 2:
Practice Address - City:SCURRY
Practice Address - State:TX
Practice Address - Zip Code:75158-4730
Practice Address - Country:US
Practice Address - Phone:469-563-7333
Practice Address - Fax:214-481-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6380261QG0250X, 261QM2500X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ3680OtherMEDICAL LICENSE