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General NPI Number Information
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NPI Number | 1659882686
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Entity Type | Organization
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Legal Business Name | A BEAUTIFUL FUTURE, LLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 2721 BILGLADE RD
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City | FORT WORTH
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State | TX
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Zip | 76133-1613
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Country | US
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Telephone | 817-503-3683
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6012
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City | FORT WORTH
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State | TX
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Zip | 76115-0012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JONATHAN ANTHONY MATA
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Credential | BSW
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Telephone | 817-503-3683
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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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