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1452 Hughes Rd Ste 200 Grapevine TX 76051-9221 | |
| (682) 233-4325 | |
| (469) 910-0473 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1452 Hughes Rd Ste 200, Grapevine, Texas |
| Authorized Official Name and Position | Sharon Rhonda Fulcher-estes (PRESIDENT/MANAGER) |
| Authorized Official Contact | 8179395077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3821 Plum Vista Pl Arlington TX 76005-4505 Ph: (817) 939-5077 | 1452 Hughes Rd Ste 200 Grapevine TX 76051-9221 Ph: (682) 233-4325 |
| NPI Number | 1063995686 |
|---|---|
| Provider Enumeration Date | 09/10/2018 |
| Last Update Date | 06/19/2023 |
| Certification Date | 06/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063995686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 18532 (Texas) | Primary |
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