| Fair Winds Assessment And Counseling Center Pllc | |
|
6551 Harris Pkwy Ste 240 Fort Worth TX 76132-6103 | |
| (817) 735-4165 | |
| (817) 735-4688 |
| Full Name | Fair Winds Assessment And Counseling Center Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 6551 Harris Pkwy Ste 240, Fort Worth, Texas |
| Authorized Official Name and Position | Bruce Feltrup-exum (PROVIDER) |
| Authorized Official Contact | 8177354165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fair Winds Assessment And Counseling Center Pllc 6551 Harris Pkwy Ste 240 Fort Worth TX 76132-6103 Ph: (817) 735-4165 | Fair Winds Assessment And Counseling Center Pllc 6551 Harris Pkwy Ste 240 Fort Worth TX 76132-6103 Ph: (817) 735-4165 |
| NPI Number | 1225544877 |
|---|---|
| Provider Enumeration Date | 12/19/2017 |
| Last Update Date | 02/06/2024 |
| Certification Date | 02/06/2024 |
| Medicare PECOS PAC ID | 9032569280 |
|---|---|
| Medicare Enrollment ID | O20231229001675 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225544877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Bruce Wayne Feltrup-exum |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1144373192 PECOS PAC ID: 0941650196 Enrollment ID: I20231229002003 |
| Provider Name | Patricia Sue Feltrup-exum |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1619926219 PECOS PAC ID: 3577906593 Enrollment ID: I20240207000651 |
| Provider Name | Victoria Ashley Icho |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1982356291 PECOS PAC ID: 3072959139 Enrollment ID: I20240311004077 |
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