Provider Demographics
NPI:1740695915
Name:NORTH TEXAS BEHAVIORAL CLINIC LLC
Entity type:Organization
Organization Name:NORTH TEXAS BEHAVIORAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABUOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:469-733-3223
Mailing Address - Street 1:715 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4695
Mailing Address - Country:US
Mailing Address - Phone:817-962-0409
Mailing Address - Fax:817-200-6743
Practice Address - Street 1:715 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4695
Practice Address - Country:US
Practice Address - Phone:817-962-0409
Practice Address - Fax:817-200-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641881363LP0808X
363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203955402Medicaid