| Go Fearless, Pllc | |
|
10935 Estate Ln Dallas TX 75238-2316 | |
| (972) 652-0703 | |
| Not Available |
| Full Name | Go Fearless, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 10935 Estate Ln, Dallas, Texas |
| Authorized Official Name and Position | Jentrelle Moore (OWNER) |
| Authorized Official Contact | 2146492141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Go Fearless, Pllc 318 Buhler Dr Garland TX 75040-7807 Ph: () - | Go Fearless, Pllc 10935 Estate Ln Dallas TX 75238-2316 Ph: (972) 652-0703 |
| NPI Number | 1831781707 |
|---|---|
| Provider Enumeration Date | 02/10/2021 |
| Last Update Date | 02/10/2021 |
| Certification Date | 02/10/2021 |
| Medicare PECOS PAC ID | 0244776094 |
|---|---|
| Medicare Enrollment ID | O20240729002271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831781707 | NPI | - | NPPES |
| 1538721808 | Other | TX | COUNSELOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jentrelle Charisma Moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538721808 PECOS PAC ID: 3072052091 Enrollment ID: I20240822000604 |
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