| Longevity Behavioral Health Center Llc | |
|
11024 Gold Pan Trl Aubrey TX 76227-4198 | |
| (214) 636-8530 | |
| Not Available |
| Full Name | Longevity Behavioral Health Center Llc |
|---|---|
| Speciality | Counselor |
| Location | 11024 Gold Pan Trl, Aubrey, Texas |
| Authorized Official Name and Position | Alicia M Johnson (OWNER) |
| Authorized Official Contact | 2146368530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Behavioral Health Center Llc 11024 Gold Pan Trl Aubrey TX 76227-4198 Ph: (214) 636-8530 | Longevity Behavioral Health Center Llc 11024 Gold Pan Trl Aubrey TX 76227-4198 Ph: (214) 636-8530 |
| NPI Number | 1811728330 |
|---|---|
| Provider Enumeration Date | 08/08/2024 |
| Last Update Date | 08/08/2024 |
| Certification Date | 08/08/2024 |
| Medicare PECOS PAC ID | 8921549627 |
|---|---|
| Medicare Enrollment ID | O20241105000904 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811728330 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Debra L Arseneaux |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407918543 PECOS PAC ID: 3476087065 Enrollment ID: I20241105001194 |
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