Green Acres Baptist Church

NPI #1437838612 in Tyler, Texas

Provider Information

NPI Number: 1437838612
Entity Type: Organization
Organization Name: Green Acres Baptist Church
Primary Specialty: Counselor - Professional
Enumeration Date: Jul 14, 2023
Last Updated: Jul 20, 2023

Practice Location

Address: 5755 EAGLES NEST BLVD STE 4
City: Tyler
State: Texas
ZIP Code: 75703-6236
Phone: (903) 533-1817

Authorized Official

Name: JAIME DAWN CORNELIUS, LPC-A
Title: CLINIC DIRECTOR
Phone: (903) 533-1817

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X
Counselor - Professional — Professional	101YP2500X	Primary

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