1023625894 DESTINATION LIFE LLC-S
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
Active
Basic Information
- Organization Name
- DESTINATION LIFE LLC-S
- Enumeration Date
- September 25, 2020
- Last Update
- July 30, 2021
- Authorized Official
- ZEMELDA D. CARR
ADM
Phone: (817) 473-1312
Practice Location
- Address
- 7 JONATHAN WAY
ELLISVILLE, MS 394375195 - Phone
- (817) 473-1312
- Fax
- (866) 990-2813
Mailing Address
- Address
- 2001 SE GREEN OAK BLVD STE 130
ARLINGTON, TX 760180952 - Phone
- (817) 473-1312
- Fax
- (866) 990-2813
Specialties & Taxonomies
| Specialty | Code | Classification | License | State | Primary |
|---|---|---|---|---|---|
| Clinical Social Worker Clinical | 1041C0700X | Social Worker | N/A | N/A | No |
| Child & Adolescent Psychiatric/Mental Health Registered Nurse Psychiatric/Mental Health, Child & Adolescent | 163WP0807X | Registered Nurse | N/A | N/A | No |
| Occupational Therapist | 225X00000X | Occupational Therapist | N/A | N/A | No |
| Mental Health Occupational Therapist Mental Health | 225XM0800X | Occupational Therapist | N/A | N/A | No |
| Primary Care Clinic/Center Primary Care | 261QP2300X | Clinic/Center | N/A | N/A | No |
| Comprehensive Outpatient Rehabilitation Facility (CORF) Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | Clinic/Center | N/A | N/A | No |
| Clinical Medical Laboratory | 291U00000X | Clinical Medical Laboratory | N/A | N/A | No |
| Nurse Practitioner | 363L00000X | Nurse Practitioner | N/A | N/A | No |
| Community Health Nurse Practitioner Community Health | 363LC1500X | Nurse Practitioner | N/A | N/A | No |
| Family Nurse Practitioner Family | 363LF0000X | Nurse Practitioner | N/A | N/A | No |
| Psychiatric/Mental Health Nurse Practitioner Psychiatric/Mental Health | 363LP0808X | Nurse Practitioner | N/A | N/A | No |
| Women's Health Nurse Practitioner Women's Health | 363LW0102X | Nurse Practitioner | N/A | N/A | No |
| Clinical Nurse Specialist | 364S00000X | Clinical Nurse Specialist | N/A | N/A | No |
| Psychiatric/Mental Health Clinical Nurse Specialist Psychiatric/Mental Health | 364SP0808X | Clinical Nurse Specialist | N/A | N/A | No |
| Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist Psychiatric/Mental Health, Child & Adolescent | 364SP0807X | Clinical Nurse Specialist | N/A | N/A | Primary |
Other Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03320311 | 05 | MS | N/A |
| 25D2200016 | 01 | MS | CLIA |
| 1C5803 | 01 | TX | GROUP |
Additional Practice Locations
1759 Broad Park Cir S Ste 113
Mansfield, TX 760637836
Mansfield, TX 760637836
Phone: (817) 473-1312
Fax: (866) 990-2813
Frequently Asked Questions
What is DESTINATION LIFE LLC-S's NPI number?
DESTINATION LIFE LLC-S's NPI number is 1023625894.
Which doctor has NPI number 1023625894?
The doctor with NPI number 1023625894 is DESTINATION LIFE LLC-S.
What is DESTINATION LIFE LLC-S's practice address?
DESTINATION LIFE LLC-S's practice address is 7 JONATHAN WAY, ELLISVILLE, MS, 394375195.
Which doctor practices at 7 JONATHAN WAY, ELLISVILLE, MS, 394375195?
DESTINATION LIFE LLC-S practices at 7 JONATHAN WAY, ELLISVILLE, MS, 394375195.
What is DESTINATION LIFE LLC-S's mailing address?
DESTINATION LIFE LLC-S's mailing address is 2001 SE GREEN OAK BLVD STE 130, ARLINGTON, TX, 760180952.
What is DESTINATION LIFE LLC-S's phone number?
DESTINATION LIFE LLC-S's phone number is (817) 473-1312.
Who is (817) 473-1312?
(817) 473-1312 is the phone number for DESTINATION LIFE LLC-S.
What is DESTINATION LIFE LLC-S's specialty?
DESTINATION LIFE LLC-S's specialty is Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist.
What type of doctor is DESTINATION LIFE LLC-S?
DESTINATION LIFE LLC-S is a Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist.
Is DESTINATION LIFE LLC-S a Psychiatric/Mental Health, Child & Adolescent?
Yes, DESTINATION LIFE LLC-S is a Psychiatric/Mental Health, Child & Adolescent.
Is DESTINATION LIFE LLC-S still practicing?
Yes, DESTINATION LIFE LLC-S is currently practicing.
Is DESTINATION LIFE LLC-S accepting new patients?
DESTINATION LIFE LLC-S may be accepting new patients. Please call their office at (817) 473-1312 to inquire about availability.
Is NPI 1023625894 still active?
Yes, NPI 1023625894 is currently active.
Where does DESTINATION LIFE LLC-S practice?
DESTINATION LIFE LLC-S practices in ELLISVILLE, MS.