MEDICARE: FULL CIRCLE COUNSELING AND FAMILY SERVICES, 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	58683	TX

General Provider Information

NPI Number	:	1255882445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE COUNSELING AND FAMILY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	17440 DALLAS PKWY
Second Line	:	SUITE 216
City	:	DALLAS
State	:	TX
Zip	:	75287-7336
Country	:	US
Telephone Number	:	469-471-4109
Fax Number	:

Provider Business Practice Location Address
First Line	:	17440 DALLAS PKWY
Second Line	:	SUITE 216
City	:	DALLAS
State	:	TX
Zip	:	75287-7336
Country	:	US
Telephone Number	:	469-471-4109
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CLINICAL DIRECTION
Name	:	ERICA SEWELL
Credential	:	LCSW, RPT, CAS
Telephone Number	:	469-471-4109

Provider Enumeration Date	:	10/22/2016
Last Update Date	:	10/22/2016

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