MEDICARE: KENYATTA BLACK COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275010308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENYATTA BLACK COUNSELING LLC

Provider Business Mailing Address
First Line	:	607 SOTOGRANDE ST
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-4456
Country	:	US
Telephone Number	:	214-298-2780
Fax Number	:	214-380-4965

Provider Business Practice Location Address
First Line	:	3939 W GREEN OAKS BLVD STE 214
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-2793
Country	:	US
Telephone Number	:	469-490-1442
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENYATTA BLACK
Credential	:
Telephone Number	:	469-490-1442

Provider Enumeration Date	:	07/21/2018
Last Update Date	:	07/08/2024

Similar Medicare Providers

1992791768 — SUSAN R REED MSSW, LCSW
Practice Location Address:

3939 W GREEN OAKS BLVD STE 206
ARLINGTON, TX
76016-2793

Practice Phone: 817-933-4878
Practice Fax:

1902188444 — KENYATTA BLACK-JACOBS M.A., LPC
Practice Location Address:

3939 W GREEN OAKS BLVD STE 214
ARLINGTON, TX
76016-2793

Practice Phone: 214-298-2780
Practice Fax: 214-380-4965

1831528710 — MR. ALANDIAZ D'ANGELO MCKINNIE LPC
Practice Location Address:

3939 W GREEN OAKS BLVD STE 214
ARLINGTON, TX
76016-2793

Practice Phone: 682-999-8520
Practice Fax:

1588049142 — CHARLES ADAM CLUCHEY LPC
Practice Location Address:

3939 W GREEN OAKS BLVD STE 206
ARLINGTON, TX
76016-2793

Practice Phone: 214-608-0701
Practice Fax:

1720664170 — MRS. NATALIE DORINE WINGARD MS
Practice Location Address:

3939 W GREEN OAKS BLVD STE 214
ARLINGTON, TX
76016-2793

Practice Phone: 469-490-1442
Practice Fax: 214-380-4965

1861145005 — VICTORIA THOMPSON LPC
Practice Location Address:

3939 W GREEN OAKS BLVD STE 214
ARLINGTON, TX
76016-2793

Practice Phone: 469-490-1442
Practice Fax: 214-380-4965

Directions to “KENYATTA BLACK COUNSELING LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.