| Lpc Medicaid Group | |
|
3840 Hulen St Htn, Client Accounting Fort Worth TX 76107-7277 | |
| (817) 569-4395 | |
| (817) 569-4517 |
| Full Name | Lpc Medicaid Group |
|---|---|
| Speciality | Counselor - Professional |
| Location | 3840 Hulen St, Fort Worth, Texas |
| Authorized Official Name and Position | Yolanda F Montes (ENROLLMENT COORDINATOR) |
| Authorized Official Contact | 8175695235 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lpc Medicaid Group Po Box 2603 Htn, Client Accounting Fort Worth TX 76113-2603 Ph: (817) 569-4395 | Lpc Medicaid Group 3840 Hulen St Htn, Client Accounting Fort Worth TX 76107-7277 Ph: (817) 569-4395 |
| NPI Number | 1437349859 |
|---|---|
| Provider Enumeration Date | 08/01/2007 |
| Last Update Date | 08/31/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437349859 | NPI | - | NPPES |
| 135082908 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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