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General NPI Number Information
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NPI Number | 1225648223
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Entity Type | Organization
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Legal Business Name | MENTAL RESILIENT SERVICES
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 2351 W NORTHWEST HWY STE 1302
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City | DALLAS
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State | TX
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Zip | 75220-8430
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Country | US
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Telephone | 469-844-7011
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Fax | 469-914-9624
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Provider Business Mailing Address
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Address Line | 2351 W NORTHWEST HWY STE 1302
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City | DALLAS
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State | TX
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Zip | 75220-8430
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Country | US
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Telephone | 469-844-7011
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Fax | 469-914-9624
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Authorized Official
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Title or Position | CEO
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Name | NYKITIA L LEDBETTER
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Credential | LPC
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Telephone | 469-844-7011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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