Healthcare Provider Details

I. General information

NPI: 1861606113
Provider Name (Legal Business Name): COVENANT KIDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WESTWAY PL SUITE 530
ARLINGTON TX
76018-5245
US

IV. Provider business mailing address

PO BOX 173038
ARLINGTON TX
76003-3038
US

V. Phone/Fax

Practice location:
  • Phone: 817-516-9100
  • Fax: 817-516-9102
Mailing address:
  • Phone: 817-516-9100
  • Fax: 817-516-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number32661
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number59857
License Number StateTX

VIII. Authorized Official

Name: LORIE GIBSON
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 817-516-9100