Provider Demographics
NPI:1902373764
Name:MOBBERLY BAPTIST CHURCH
Entity Type:Organization
Organization Name:MOBBERLY BAPTIST CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR OF MARRIAGE & FAMILY COUNSEL
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACKARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-252-4673
Mailing Address - Street 1:625 E LOOP 281
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5004
Mailing Address - Country:US
Mailing Address - Phone:903-663-7361
Mailing Address - Fax:
Practice Address - Street 1:3032 N EASTMAN RD STE LONGVIEW
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5019
Practice Address - Country:US
Practice Address - Phone:903-252-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBBERLY BAPTIST CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health