MEDICARE: I CATRENA BOSWELL, PLLC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1225656747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I CATRENA BOSWELL, PLLC

Provider Business Mailing Address
First Line	:	4200 S HULEN ST STE 682
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-7905
Country	:	US
Telephone Number	:	817-385-1529
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 S HULEN ST STE 682
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-7905
Country	:	US
Telephone Number	:	817-385-1529
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	CATRENA BOSWELL
Credential	:	LCSW
Telephone Number	:	817-385-1529

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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