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General NPI Number Information
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NPI Number | 1679087076
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Entity Type | Organization
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Legal Business Name | GENETIC RISK CONSULTING, PA
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 9430 COUNTY ROAD 4074
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City | SCURRY
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State | TX
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Zip | 75158-4730
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Country | US
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Telephone | 469-563-7333
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Fax | 214-481-7238
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Provider Business Mailing Address
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Address Line | 9430 COUNTY ROAD 4074
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City | SCURRY
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State | TX
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Zip | 75158-4730
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Country | US
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Telephone | 469-563-7333
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Fax | 214-481-7238
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Authorized Official
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Title or Position | PRESIDENT
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Name | YVETTE CLIFFORD
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Credential | MD
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Telephone | 469-563-7333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | J6380
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | J6380
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number | J6380
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License Number State | TX
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