Healthcare Provider Details

I. General information

NPI: 1710707872
Provider Name (Legal Business Name): APTUS LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES RD STE 103
GRAPEVINE TX
76051-7452
US

IV. Provider business mailing address

3839 MCKINNEY AVE STE 155
DALLAS TX
75204-1488
US

V. Phone/Fax

Practice location:
  • Phone: 817-891-3405
  • Fax:
Mailing address:
  • Phone: 817-891-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAY SERBIN BRENNER
Title or Position: FOUNDER
Credential:
Phone: 817-891-3405