MEDICARE: GEEK THERAPEUTICS 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	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1508503103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEEK THERAPEUTICS PLLC

Provider Business Mailing Address
First Line	:	909 9TH AVE STE 208
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3931
Country	:	US
Telephone Number	:	833-369-1144
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 9TH AVE STE 208
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3931
Country	:	US
Telephone Number	:	682-231-2420
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANTHONY BEAN
Credential	:	PHD
Telephone Number	:	413-563-2729

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	01/28/2026

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