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General NPI Number Information
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NPI Number | 1407446362
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Entity Type | Organization
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Legal Business Name | COMFORT MINDS & ABOVE LLC
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Dates
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Enumeration Date | 01/24/2021
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Last Update Date | 01/24/2021
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Provider Practice Location Address
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Address Line | 9500 RAY WHITE RD STE 200
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City | FORT WORTH
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State | TX
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Zip | 76244-9105
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Country | US
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Telephone | 214-418-6227
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 RAY WHITE RD STE 200
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City | FORT WORTH
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State | TX
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Zip | 76244-9105
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Country | US
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Telephone | 214-418-6227
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHUNTAK JERIDEAU
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Credential | PMHNP
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Telephone | 214-418-6227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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