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General NPI Number Information
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NPI Number | 1023972270
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Entity Type | Organization
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Legal Business Name | PARIAH VENTURES GROUP LLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 702 W STATE HIGHWAY 71 # 1015
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City | BASTROP
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State | TX
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Zip | 78602-4029
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Country | US
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Telephone | 979-505-9174
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Fax | 855-945-3878
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Provider Business Mailing Address
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Address Line | 702 W STATE HIGHWAY 71 # 1015
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City | BASTROP
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State | TX
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Zip | 78602-4029
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Country | US
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Telephone | 979-505-9174
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Fax | 855-945-3878
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. LAKEISHA YVETTE MOORE
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Credential | LCSW
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Telephone | 979-661-1213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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