MEDICARE: JENA LYNN DARLING LPC

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	101YM0800X	Mental Health Counselor	64102	TX

General Provider Information

NPI Number	:	1700171907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENA LYNN DARLING LPC

Provider Business Mailing Address
First Line	:	4 CIMARRON CT
Second Line	:
City	:	TROPHY CLUB
State	:	TX
Zip	:	76262-5212
Country	:	US
Telephone Number	:	817-491-7202
Fax Number	:	817-255-2657

Provider Business Practice Location Address
First Line	:	3800 HULEN ST
Second Line	:	SUITE 150
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7276
Country	:	US
Telephone Number	:	817-255-2670
Fax Number	:	817-255-2657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	08/24/2011

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