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General NPI Number Information
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NPI Number | 1104514306
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Entity Type | Organization
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Legal Business Name | INNER SELF BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 07/04/2023
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Provider Practice Location Address
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Address Line | 6850 MANHATTAN BLVD STE 300-19
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City | FORT WORTH
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State | TX
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Zip | 76120-1227
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Country | US
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Telephone | 817-631-1298
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Fax |
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Provider Business Mailing Address
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Address Line | 6850 MANHATTAN BLVD STE 300-19
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City | FORT WORTH
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State | TX
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Zip | 76120-1227
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Country | US
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Telephone | 972-841-3706
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | MS. SATANG ANN
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Credential | APRN
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Telephone | 972-841-3706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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