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General NPI Number Information
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NPI Number | 1023530649
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Entity Type | Organization
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Legal Business Name | LYNDA CARMOUCHE PSYCHOTHERAPY & TRAINING, PLLC
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 07/14/2017
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Provider Practice Location Address
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Address Line | 5601 BRIDGE ST
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City | FORT WORTH
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State | TX
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Zip | 76112-2384
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Country | US
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Telephone | 214-273-5045
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Fax | 337-205-0814
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Provider Business Mailing Address
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Address Line | PO BOX 613174
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City | DALLAS
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State | TX
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Zip | 75261-3174
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Country | US
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Telephone | 214-273-5045
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Fax | 337-205-0814
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MS. LINDA ANN CARMOUCHE
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Credential | LCSW
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Telephone | 214-273-5045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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