Life Gate Church Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

LIFE GATE CHURCH INC

Practice address

102 Bayne Rd
Haslet, TX 76052-4614

Phone

(817) 675-8135

NPI assigned

Feb 6, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles C Borsellino, MD

Title

Manager

Phone

(817) 966-9310

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333497600000",
    "number": "1013289149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 BAYNE RD",
            "city": "HASLET",
            "state": "TX",
            "postal_code": "760524614",
            "telephone_number": "817-675-8135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 BAYNE RD",
            "city": "HASLET",
            "state": "TX",
            "postal_code": "760524614",
            "telephone_number": "817-675-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE GATE CHURCH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-06",
        "last_updated": "2012-04-04",
        "status": "A",
        "authorized_official_last_name": "BORSELLINO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "817-966-9310",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Haslet, TX
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• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.