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General NPI Number Information
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NPI Number | 1871985499
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Entity Type | Organization
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Legal Business Name | BEYOND THE VEIL
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 7724 MARBLE CANYON DR
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City | FORT WORTH
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State | TX
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Zip | 76137-4156
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Country | US
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Telephone | 817-455-6022
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Fax |
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Provider Business Mailing Address
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Address Line | 7724 MARBLE CANYON DR
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City | FORT WORTH
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State | TX
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Zip | 76137-4156
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Country | US
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Telephone | 817-455-6022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH BANFILL
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Credential | LPN
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Telephone | 817-455-6022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 18558699436
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License Number State | TX
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