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NPI Code Detail

MEDICARE: LAVENDER HEALING CENTER, PLLC

MEDICARE: LAVENDER HEALING CENTER, 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
1101YM0800XMental Health Counselor
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QM0850XAdult Mental Health Clinic/Center
4106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1538828165
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAVENDER HEALING CENTER, PLLC
Provider Business Mailing Address
First Line : 8101 BOAT CLUB ROAD
Second Line : SUITE 240 BOX 1070
City : FORT WORTH
State : TX
Zip : 76179
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6029 SHINER DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76179-7639
Country : US
Telephone Number : 228-918-0984
Fax Number :
Authorized Official
Title or Position : THERAPIST
Name : MRS. KASEY SCHARNETT KING
Credential : LMFT
Telephone Number : 228-918-0984
Provider Enumeration Date : 12/10/2021
Last Update Date : 01/04/2022

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Directions to “LAVENDER HEALING CENTER, PLLC ” Practice Location

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