Mungadze, Jerry J.
Mungadze, Jerry J. is an sole proprietor health care provider with primary practice located at 2040 Bedford Rd Ste 200 , Bedford TX 76021-5871. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Mungadze, Jerry J. can be contacted via phone (817) 354-1389.Contact Information
Primary practice address
2040 Bedford Rd Ste 200
Bedford TX 76021-5871
Phone: (817) 354-1389
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 10315 | Texas |
Profile Details
| NPI number | 1356490080 |
|---|---|
| LBN Legal business name | Mungadze, Jerry J. |
| Credentials | PHD., LPC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 10th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356490080 | NPPES |
| Texas | Other | 7323LC | BLUECROSS BLUE SHIELD |
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