Provider Demographics
NPI:1831365634
Name:LAKE ARLINGTON BAPTIST CHURCH
Entity type:Organization
Organization Name:LAKE ARLINGTON BAPTIST CHURCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, IMPACT COUNSELING & GUIDA
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAYMANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD ED, LPC, LMFT,
Authorized Official - Phone:817-457-6728
Mailing Address - Street 1:2912 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1725
Mailing Address - Country:US
Mailing Address - Phone:817-457-6728
Mailing Address - Fax:817-451-7732
Practice Address - Street 1:2912 LITTLE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1725
Practice Address - Country:US
Practice Address - Phone:817-457-6728
Practice Address - Fax:817-451-7732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE ARLINGTON BAPTIST CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)