Individual provider Active NPI

Brooklyn Paul

  • Adult Mental Health Clinic/Center
  • Fort Worth, TX
National Provider Identifier
1760056790
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Practice address
5070 Tierney CT N
Fort Worth, TX 76112-2828
Phone
(682) 227-0600
NPI assigned
May 14, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

5070 Tierney CT N
Fort Worth, TX 76112-2828

Mailing address

301 W FM 1187 Apt 3309
Crowley, TX 76036-3593
Phone (682) 227-0600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address btpaul58@live.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
New Beginnings Adult Mental Health Adult Mental Health Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1620950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1760056790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W FM 1187 APT 3309",
            "city": "CROWLEY",
            "state": "TX",
            "postal_code": "760363593",
            "telephone_number": "682-227-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5070 TIERNEY CT N",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761122828",
            "telephone_number": "682-227-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUL",
        "first_name": "BROOKLYN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-14",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "btpaul58@live.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5070 Tierney Ct N",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761122828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; 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.