Provider Demographics
NPI:1427514553
Name:FAST BEHAVORIAL HEALTH CORPORATION
Entity type:Organization
Organization Name:FAST BEHAVORIAL HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEGBOYEGA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOBA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:817-704-8116
Mailing Address - Street 1:1406 ANGLICAN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3741
Mailing Address - Country:US
Mailing Address - Phone:817-704-8116
Mailing Address - Fax:
Practice Address - Street 1:1406 ANGLICAN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3741
Practice Address - Country:US
Practice Address - Phone:817-704-8116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty