Healthcare Provider Details

I. General information

NPI: 1164648465
Provider Name (Legal Business Name): CORRIE E HEDDEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETSY E HEDDEN LPC

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 7TH AVE STE 4124
FORT WORTH TX
76104-2722
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-7439
  • Fax: 682-885-1672
Mailing address:
  • Phone: 682-885-1860
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number74004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: