| Kick In The Ass Counseling | |
|
4200 South Fwy Ste 520 Fort Worth TX 76115-1406 | |
| (817) 495-9776 | |
| Not Available |
| Full Name | Kick In The Ass Counseling |
|---|---|
| Speciality | Counselor |
| Location | 4200 South Fwy Ste 520, Fort Worth, Texas |
| Authorized Official Name and Position | Victoria Gonzales (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8174959776 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kick In The Ass Counseling 4200 South Fwy Ste 520 Fort Worth TX 76115-1406 Ph: (817) 495-9776 | Kick In The Ass Counseling 4200 South Fwy Ste 520 Fort Worth TX 76115-1406 Ph: (817) 495-9776 |
| NPI Number | 1982319992 |
|---|---|
| Provider Enumeration Date | 01/16/2023 |
| Last Update Date | 10/18/2024 |
| Certification Date | 10/18/2024 |
| Medicare PECOS PAC ID | 6507206810 |
|---|---|
| Medicare Enrollment ID | O20240503001793 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982319992 | NPI | - | NPPES |
| 86035 | Other | TX | LPC LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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