Provider Demographics
NPI:1871985499
Name:BEYOND THE VEIL
Entity type:Organization
Organization Name:BEYOND THE VEIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANFILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:817-455-6022
Mailing Address - Street 1:7724 MARBLE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4156
Mailing Address - Country:US
Mailing Address - Phone:817-455-6022
Mailing Address - Fax:
Practice Address - Street 1:7724 MARBLE CANYON DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4156
Practice Address - Country:US
Practice Address - Phone:817-455-6022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEYOND THE VEIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18558699436261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service