MEDICARE: HIS AMBASSADORS HEALTH CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1649112269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIS AMBASSADORS HEALTH CENTER

Provider Business Mailing Address
First Line	:	14842 CANYONRIDGE DR
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-3644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14842 CANYONRIDGE DR
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-3644
Country	:	US
Telephone Number	:	214-994-0418
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IGNATIUS AGBOR
Credential	:
Telephone Number	:	214-994-0418

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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