Healthcare Provider Details

I. General information

NPI: 1689461048
Provider Name (Legal Business Name): 290 THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6096 DETERMINE LN
FORNEY TX
75126-3974
US

IV. Provider business mailing address

6096 DETERMINE LN
FORNEY TX
75126-3974
US

V. Phone/Fax

Practice location:
  • Phone: 309-490-4853
  • Fax: 309-326-4497
Mailing address:
  • Phone: 309-490-4853
  • Fax: 309-326-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TYRA FERRELL STEVERSON
Title or Position: OWNER
Credential: LPC
Phone: 309-490-4853