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General NPI Number Information
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NPI Number | 1134488067
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Entity Type | Organization
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Legal Business Name | FOCUSED &FAVORED YOUTH CENTER
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Dates
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Enumeration Date | 05/12/2012
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Last Update Date | 05/12/2012
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Provider Practice Location Address
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Address Line | 2560 DAUPHINE PL
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City | BEAUMONT
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State | TX
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Zip | 77705-4627
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Country | US
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Telephone | 832-248-4585
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 DAUPHINE PL
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City | BEAUMONT
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State | TX
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Zip | 77705-4627
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Country | US
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Telephone | 832-248-4585
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARLIN BECKETT
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Credential |
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Telephone | 832-248-4585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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