MEDICARE: THERAPY TOWARD WHOLENESS, 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	56953	TX

General Provider Information

NPI Number	:	1881042414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY TOWARD WHOLENESS, PLLC

Provider Business Mailing Address
First Line	:	5613 ADAMS AVE
Second Line	:	SUITE 404
City	:	AUSTIN
State	:	TX
Zip	:	78756-1136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5613 ADAMS AVE
Second Line	:	SUITE 404
City	:	AUSTIN
State	:	TX
Zip	:	78756-1136
Country	:	US
Telephone Number	:	512-969-0847
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRUE HARDT
Credential	:
Telephone Number	:	512-969-0847

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/01/2017

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