Provider Demographics
NPI:1023760808
Name:COURAGEOUS COACHING MT LLC
Entity type:Organization
Organization Name:COURAGEOUS COACHING MT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIGNON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:409-679-9338
Mailing Address - Street 1:4385 CORLEY ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4433
Mailing Address - Country:US
Mailing Address - Phone:409-235-1400
Mailing Address - Fax:877-920-1977
Practice Address - Street 1:4385 CORLEY ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4433
Practice Address - Country:US
Practice Address - Phone:409-235-1400
Practice Address - Fax:877-920-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251K00000XAgenciesPublic Health or Welfare