Provider Demographics
NPI:1699470047
Name:NORTH TEXAS BEHAVIORAL CLINIC LLC
Entity type:Organization
Organization Name:NORTH TEXAS BEHAVIORAL CLINIC LLC
Other - Org Name:<UNAVAIL>
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:
Authorized Official - Phone:817-962-0409
Mailing Address - Street 1:3084 W HIGHWAY 287 BYP
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-5000
Mailing Address - Country:US
Mailing Address - Phone:817-962-0409
Mailing Address - Fax:817-200-6743
Practice Address - Street 1:3084 W HIGHWAY 287 BYP
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75167-5000
Practice Address - Country:US
Practice Address - Phone:817-962-0409
Practice Address - Fax:817-200-6743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH TEXAS BEHAVIORAL CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-04
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health