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General NPI Number Information
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NPI Number | 1023760808
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Entity Type | Organization
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Legal Business Name | COURAGEOUS COACHING MT LLC
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Dates
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Enumeration Date | 01/22/2022
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Last Update Date | 01/22/2022
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Provider Practice Location Address
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Address Line | 4385 CORLEY ST
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City | BEAUMONT
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State | TX
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Zip | 77707-4433
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Country | US
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Telephone | 409-235-1400
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Fax | 877-920-1977
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Provider Business Mailing Address
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Address Line | 4385 CORLEY ST
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City | BEAUMONT
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State | TX
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Zip | 77707-4433
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Country | US
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Telephone | 409-235-1400
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Fax | 877-920-1977
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MRS. MIGNON THOMAS
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Credential | LVN
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Telephone | 409-679-9338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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