MEDICARE: GENESIS FACTOR INTERNATIONAL INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QC1500X	Community Health Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	261QM0850X	Adult Mental Health Clinic/Center
6	261QM0855X	Adolescent and Children Mental Health Clinic/Center
7	261QM1000X	Migrant Health Clinic/Center
8	261QR0800X	Recovery Care Clinic/Center
9	385H00000X	Respite Care
10	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1477167591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS FACTOR INTERNATIONAL INC.

Provider Business Mailing Address
First Line	:	6387B CAMP BOWIE BLVD # 629
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5423
Country	:	US
Telephone Number	:	817-983-2077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2917 BUCKSKIN RUN APT 808
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-9601
Country	:	US
Telephone Number	:	817-983-2077
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MS. CASSANDRA LAMPTEY
Credential	:	MASTER IN COUNSELING
Telephone Number	:	817-983-2077

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/04/2020

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Directions to “GENESIS FACTOR INTERNATIONAL INC. ” Practice Location

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