Healthcare Provider Details

I. General information

NPI: 1275472862
Provider Name (Legal Business Name): THREE LIGHTS COMMUNITY HEALTH OUTREACH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 BURNET DR
MESQUITE TX
75181-2696
US

IV. Provider business mailing address

1017 BURNET DR
MESQUITE TX
75181-2696
US

V. Phone/Fax

Practice location:
  • Phone: 214-962-4537
  • Fax: 972-544-1517
Mailing address:
  • Phone: 214-962-4537
  • Fax: 972-544-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HASSANATU MICHAEL
Title or Position: DIRECTOR
Credential: MICHAEL
Phone: 214-962-4537