Organization
NCLB- NO CHILD LEFT BEHIND INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FATESA BATEMAN (EXECUTIVE DIRECTOR)
(972) 922-2761
Entity
Organization
Contact information
Practice address
2701 S GREAT SOUTHWEST PKWY, GRAND PRAIRIE, TX 75052-7231
(972) 922-2761
Mailing address
2701 S GREAT SOUTHWEST PKWY, GRAND PRAIRIE, TX 75052-7231
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9729222761
MEDICAID
TX
Enumeration date
10/01/2014
Last updated
10/01/2014
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