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General NPI Number Information
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NPI Number | 1730567462
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Entity Type | Organization
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Legal Business Name | TEXAS ADVANCE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 715 N FIELDER RD
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City | ARLINGTON
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State | TX
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Zip | 76012-4695
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Country | US
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Telephone | 682-220-9615
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Fax | 817-200-6813
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Provider Business Mailing Address
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Address Line | 715 N FIELDER RD
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City | ARLINGTON
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State | TX
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Zip | 76012-4695
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Country | US
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Telephone | 682-220-9615
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Fax | 817-200-6813
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MARIA MOSOMI
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Credential | PMHNP-BC
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Telephone | 682-220-9615
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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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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 748914
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License Number State | TX
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