MEDICARE: WELLMIND THERAPY CENTER

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	261QM1300X	Multi-Specialty Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1932936424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLMIND THERAPY CENTER

Provider Business Mailing Address
First Line	:	3418 N TARRANT PKWY STE 320
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 N TARRANT PKWY STE 320
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8646
Country	:	US
Telephone Number	:	682-378-0808
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LAUREN TECONCHUK
Credential	:
Telephone Number	:	682-378-0808

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	08/06/2025

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Directions to “WELLMIND THERAPY CENTER ” Practice Location

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