| Life Gate Church Inc | |
|
102 Bayne Rd Haslet TX 76052-4614 | |
| (817) 675-8135 | |
| Not Available |
| Full Name | Life Gate Church Inc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 102 Bayne Rd, Haslet, Texas |
| Authorized Official Name and Position | Charles C Borsellino (MANAGER) |
| Authorized Official Contact | 8179669310 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Gate Church Inc 102 Bayne Rd Haslet TX 76052-4614 Ph: (817) 675-8135 | Life Gate Church Inc 102 Bayne Rd Haslet TX 76052-4614 Ph: (817) 675-8135 |
| NPI Number | 1013289149 |
|---|---|
| Provider Enumeration Date | 02/06/2012 |
| Last Update Date | 04/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013289149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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