Provider Demographics
NPI:1578309134
Name:UNIQUE BEHAVIORAL CLINIC PLLC
Entity type:Organization
Organization Name:UNIQUE BEHAVIORAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AJIBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAT-ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-215-7332
Mailing Address - Street 1:1821 N 23RD ST # 122
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-8538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1821 N 23RD ST # 122
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-8538
Practice Address - Country:US
Practice Address - Phone:956-215-7332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty