MEDICARE: LOYAL LIVING LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1144956673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOYAL LIVING LLC.

Provider Business Mailing Address
First Line	:	PO BOX 181698
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76096-1698
Country	:	US
Telephone Number	:	214-900-8360
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 MT VERNON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2527
Country	:	US
Telephone Number	:	214-900-8360
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	ROBERT SHELTON
Credential	:
Telephone Number	:	214-900-8360

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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Directions to “LOYAL LIVING LLC. ” Practice Location

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