Healthcare Provider Details

I. General information

NPI: 1548811292
Provider Name (Legal Business Name): MIIBOSO CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W BARDIN RD STE 202
ARLINGTON TX
76017-6000
US

IV. Provider business mailing address

901 W BARDIN RD STE 202
ARLINGTON TX
76017-6000
US

V. Phone/Fax

Practice location:
  • Phone: 682-323-5402
  • Fax: 682-323-5402
Mailing address:
  • Phone: 682-323-5402
  • Fax: 682-323-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: CHARMAINE STITH
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC-S
Phone: 225-993-1535