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Organization
GREEN ACRES BAPTIST CHURCH
Active
Organization
GREEN ACRES BAPTIST CHURCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIME DAWN CORNELIUS LPC-A (CLINIC DIRECTOR)
(903) 533-1817
Entity
Organization
Contact information
Practice address
5755 EAGLES NEST BLVD STE 4, TYLER, TX 75703-6236
(903) 533-1817
Mailing address
1607 TROUP HWY, TYLER, TX 75701-5799
(903) 533-1817
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
07/14/2023
Last updated
07/20/2023
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