Provider Demographics
NPI:1538909940
Name:JAZZYS SERENITY BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:JAZZYS SERENITY BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MBAABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-883-5814
Mailing Address - Street 1:1512 CHICKADEE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6554
Mailing Address - Country:US
Mailing Address - Phone:817-883-5814
Mailing Address - Fax:
Practice Address - Street 1:808 SW GREEN OAKS BLVD STE 402
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-6233
Practice Address - Country:US
Practice Address - Phone:817-883-5814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty