MEDICARE: HCSVS MENTAL HEALTH TELEMEDICINE STARTUP PBC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1215726047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HCSVS MENTAL HEALTH TELEMEDICINE STARTUP PBC

Provider Business Mailing Address
First Line	:	1125 GARDEN ST
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-4304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 HOUSTON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5004
Country	:	US
Telephone Number	:	347-515-2417
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	LAURENCE GIRARD
Credential	:
Telephone Number	:	347-515-2417

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/06/2025

Similar Medicare Providers

1417636309 — MODERN RECOVERY, LLC
Practice Location Address:

702 HOUSTON ST # 118
FORT WORTH, TX
76102-5004

Practice Phone: 203-200-8556
Practice Fax:

1700656519 — THE CARE COMPANY LLC
Practice Location Address:

702 HOUSTON ST STE 175
FORT WORTH, TX
76102-5004

Practice Phone: 817-813-8655
Practice Fax:

1861257776 — VIBRANT MENTAL WELLNESS LLC
Practice Location Address:

702 HOUSTON ST
FORT WORTH, TX
76102-5004

Practice Phone: 763-568-6378
Practice Fax:

1588422265 — CHIQUITA M WILLIAMS
Practice Location Address:

702 HOUSTON ST STE 132
FORT WORTH, TX
76102-5004

Practice Phone: 682-267-3858
Practice Fax:

1194725002 — FOOT & ANKLE GROUP OF SOUTHWEST FLORIDA, PA
Practice Location Address:

7117 CONGDON RD APT 200
FORT MYERS, FL
33908-5004

Practice Phone: 239-936-5400
Practice Fax: 239-936-9572

1255320206 — MR. ROGER DUANE EAKS LCSW
Practice Location Address:

USA MEDDAC ATTN: CREDENTIALS , 11050 MT BELVEDERE BLVD
FORT DRUM, NY
13602-5004

Practice Phone: 315-772-4025
Practice Fax: 315-772-9498

Directions to “HCSVS MENTAL HEALTH TELEMEDICINE STARTUP PBC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.