| Lena Pope Home, Inc. | |
|
3200 Sanguinet St Fort Worth TX 76107-5355 | |
| (817) 255-2652 | |
| (817) 255-2657 |
| Full Name | Lena Pope Home, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 3200 Sanguinet St, Fort Worth, Texas |
| Authorized Official Name and Position | Merry Ashley Elgin (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8172552500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lena Pope Home, Inc. 3200 Sanguinet St Fort Worth TX 76107-5355 Ph: (817) 255-2652 | Lena Pope Home, Inc. 3200 Sanguinet St Fort Worth TX 76107-5355 Ph: (817) 255-2652 |
| NPI Number | 1093856924 |
|---|---|
| Provider Enumeration Date | 02/12/2007 |
| Last Update Date | 04/23/2024 |
| Certification Date | 04/23/2024 |
| Medicare PECOS PAC ID | 0143230631 |
|---|---|
| Medicare Enrollment ID | O20060427000714 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093856924 | NPI | - | NPPES |
| 108336204 | Medicaid | TX | |
| 108336205 | Medicaid | TX | |
| 108336202 | Medicaid | TX | |
| 328306101 | Medicaid | TX | |
| 108336203 | Medicaid | TX | |
| 332123401 | Medicaid | TX |
| Provider Name | Shana Leigh Hazzard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407003197 PECOS PAC ID: 7113102310 Enrollment ID: I20110504000155 |
| Provider Name | Paul E Blankenship |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972096832 PECOS PAC ID: 6002255643 Enrollment ID: I20240416002651 |
| Provider Name | Ora Beth Mcmullen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578171237 PECOS PAC ID: 7214376326 Enrollment ID: I20240422001353 |
| Provider Name | Julie Annette Foster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124690722 PECOS PAC ID: 4789024720 Enrollment ID: I20240424003379 |
| Provider Name | Courtney Siegel Landes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437514320 PECOS PAC ID: 1557701349 Enrollment ID: I20240426001062 |
| Provider Name | Dawn Marie Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558611277 PECOS PAC ID: 6709007073 Enrollment ID: I20240426001488 |
| Provider Name | Aurelia Yvette Cortez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053194282 PECOS PAC ID: 8022458835 Enrollment ID: I20240426001903 |
| Provider Name | Jacob Lloyd Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780447268 PECOS PAC ID: 0042650871 Enrollment ID: I20240426002540 |
| Provider Name | Lauren Mackenzie Cox-mankowski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518445097 PECOS PAC ID: 4981044716 Enrollment ID: I20240426002796 |
| Provider Name | Kristen Mcneill |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386023380 PECOS PAC ID: 4981044641 Enrollment ID: I20240429000145 |
| Provider Name | Imelda De La Cruz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093443202 PECOS PAC ID: 9133569890 Enrollment ID: I20240429000184 |
| Provider Name | Mariah Delainey Cordery |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669090205 PECOS PAC ID: 0840630505 Enrollment ID: I20240429000281 |
| Provider Name | Megan Elizabeth Canale |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891249116 PECOS PAC ID: 2567802226 Enrollment ID: I20240429000312 |
| Provider Name | Kent Alan Bass |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265659932 PECOS PAC ID: 1557701216 Enrollment ID: I20240429000339 |
| Provider Name | Tela Hedberg Thornton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013680198 PECOS PAC ID: 0547600215 Enrollment ID: I20240429000402 |
| Provider Name | Lauren Elise Doane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720773021 PECOS PAC ID: 9931549565 Enrollment ID: I20240430003270 |
| Provider Name | Dakota B Phelps |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801385703 PECOS PAC ID: 9830539469 Enrollment ID: I20240430003286 |
| Provider Name | Paola Karla Gordillo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396529236 PECOS PAC ID: 8224478573 Enrollment ID: I20240502004004 |
| Provider Name | Derek Atauyo Bassey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487362703 PECOS PAC ID: 9133560618 Enrollment ID: I20240515001605 |
| Provider Name | Anita Sharma |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912172966 PECOS PAC ID: 9436591096 Enrollment ID: I20240528002738 |
| Provider Name | Karen Melendez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841048923 PECOS PAC ID: 1951844398 Enrollment ID: I20240613003748 |
| Provider Name | Elizabeth B Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821419482 PECOS PAC ID: 7517400963 Enrollment ID: I20240613004002 |
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