| Eternal Bliss, Llc | |
|
4500 Mercantile Plaza Dr Ste 300 Fort Worth TX 76137-4206 | |
| (817) 476-0317 | |
| Not Available |
| Full Name | Eternal Bliss, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4500 Mercantile Plaza Dr Ste 300, Fort Worth, Texas |
| Authorized Official Name and Position | Laquindra Carroll (OWNER) |
| Authorized Official Contact | 8174760317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eternal Bliss, Llc 4204 Bent Oaks Dr Arlington TX 76001-5157 Ph: (817) 476-0317 | Eternal Bliss, Llc 4500 Mercantile Plaza Dr Ste 300 Fort Worth TX 76137-4206 Ph: (817) 476-0317 |
| NPI Number | 1942883905 |
|---|---|
| Provider Enumeration Date | 04/28/2021 |
| Last Update Date | 10/23/2021 |
| Certification Date | 09/10/2021 |
| Medicare PECOS PAC ID | 8921499955 |
|---|---|
| Medicare Enrollment ID | O20211229001091 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942883905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Laquindra M Carroll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194316083 PECOS PAC ID: 8729495734 Enrollment ID: I20210318000322 |
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