| Positive Impact Therapeutic Services | |
|
12650 N Beach St Ste 114 Fort Worth TX 76244-4245 | |
| (832) 338-4711 | |
| Not Available |
| Full Name | Positive Impact Therapeutic Services |
|---|---|
| Speciality | Counselor - Professional |
| Location | 12650 N Beach St Ste 114, Fort Worth, Texas |
| Authorized Official Name and Position | Marnee Crutchfield (ADMINISTRATOR) |
| Authorized Official Contact | 8323384711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Impact Therapeutic Services 12650 N Beach St Ste 114 Fort Worth TX 76244-4245 Ph: () - | Positive Impact Therapeutic Services 12650 N Beach St Ste 114 Fort Worth TX 76244-4245 Ph: (832) 338-4711 |
| NPI Number | 1124455571 |
|---|---|
| Provider Enumeration Date | 10/01/2013 |
| Last Update Date | 10/01/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124455571 | NPI | - | NPPES |
| 203432401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 19337 (Texas) | Primary |
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