Provider Demographics
NPI:1952926321
Name:HEALING HOPE BEHAVIORAL CLINIC LLC
Entity Type:Organization
Organization Name:HEALING HOPE BEHAVIORAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:NSOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:469-225-3670
Mailing Address - Street 1:733 HIGHWAY 287 N STE 403
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3865
Mailing Address - Country:US
Mailing Address - Phone:469-225-3670
Mailing Address - Fax:817-549-7630
Practice Address - Street 1:733 HIGHWAY 287 N STE 403
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3865
Practice Address - Country:US
Practice Address - Phone:469-225-3670
Practice Address - Fax:817-549-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX414665601Medicaid