Provider Demographics
NPI:1841558681
Name:JEAN MASSIEU ACADEMY
Entity Type:Organization
Organization Name:JEAN MASSIEU ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHBEHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-460-0396
Mailing Address - Street 1:823 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5859
Mailing Address - Country:US
Mailing Address - Phone:817-460-0396
Mailing Address - Fax:817-460-9867
Practice Address - Street 1:823 N CENTER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5859
Practice Address - Country:US
Practice Address - Phone:817-460-0396
Practice Address - Fax:817-460-9867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid