Healthcare Provider Details
I. General information
NPI: 1801467188
Provider Name (Legal Business Name): HURD COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/07/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3815 LISBON ST STE 202
FORT WORTH TX
76107-5673
US
IV. Provider business mailing address
1905 RIO COSTILLA RD
FORT WORTH TX
76131-1655
US
V. Phone/Fax
- Phone: 817-320-2094
- Fax:
- Phone: 682-231-3656
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM1300X |
| Taxonomy | Multi-Specialty Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
KIMBERLY
ANN SLAVICH
HURD
Title or Position: LPC
Credential:
Phone: 817-320-2094