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General NPI Number Information
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NPI Number | 1144956673
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Entity Type | Organization
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Legal Business Name | LOYAL LIVING LLC.
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 3504 MT VERNON AVE
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City | FORT WORTH
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State | TX
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Zip | 76103-2527
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Country | US
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Telephone | 214-900-8360
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 181698
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City | ARLINGTON
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State | TX
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Zip | 76096-1698
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Country | US
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Telephone | 214-900-8360
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | ROBERT SHELTON
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Credential |
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Telephone | 214-900-8360
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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