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NPI Code Detail

MEDICARE: KIDS CAN FLY FOUNDATION

MEDICARE: KIDS CAN FLY FOUNDATION
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
1101Y00000XCounselorLPC 959TX
2101YA0400XAddiction (Substance Use Disorder) CounselorLPC 959TX
3101YM0800XMental Health CounselorLPC 959TX
4106H00000XMarriage & Family TherapistLMFT 469TX
5101YP2500XProfessional CounselorLPC 959TX

General Provider Information

NPI Number : 1851654735
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS CAN FLY FOUNDATION
Provider Business Mailing Address
First Line : 1101 CRAZY HORSE TRL
Second Line :
City : BURLESON
State : TX
Zip : 76028-7845
Country : US
Telephone Number : 817-807-5932
Fax Number : 972-377-6091
Provider Business Practice Location Address
First Line : 1201 W NORTH CARRIER PKWY
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75050-8102
Country : US
Telephone Number : 817-807-5932
Fax Number : 972-377-6091
Authorized Official
Title or Position : EXECUTIVE DIRECTOR/ ADMINISTRATOR
Name : MR. ROBERT H. O'NEAL
Credential : LPC, LMFT
Telephone Number : 817-807-5932
Provider Enumeration Date : 06/16/2012
Last Update Date : 06/16/2012

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