MEDICARE: MEND & MOVE THERAPY, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1225991375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEND & MOVE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	7216 HOGAN DR
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-4583
Country	:	US
Telephone Number	:	770-557-5647
Fax Number	:

Provider Business Practice Location Address
First Line	:	7216 HOGAN DR
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-4583
Country	:	US
Telephone Number	:	770-557-5647
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA KENNEDY
Credential	:	LCSW
Telephone Number	:	770-557-5647

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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