Organization
LIFE GATE CHURCH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES C BORSELLINO MD (MANAGER)
(817) 966-9310
Entity
Organization
Contact information
Practice address
102 BAYNE RD, HASLET, TX 76052-4614
(817) 675-8135
Mailing address
102 BAYNE RD, HASLET, TX 76052-4614
(817) 675-8135
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
02/06/2012
Last updated
04/04/2012
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