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General NPI Number Information
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NPI Number | 1225544877
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Entity Type | Organization
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Legal Business Name | FAIR WINDS ASSESSMENT AND COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 6551 HARRIS PKWY STE 240
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City | FORT WORTH
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State | TX
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Zip | 76132-6103
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Country | US
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Telephone | 817-735-4165
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Fax | 817-735-4688
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Provider Business Mailing Address
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Address Line | 6551 HARRIS PKWY STE 240
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City | FORT WORTH
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State | TX
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Zip | 76132-6103
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Country | US
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Telephone | 817-735-4165
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Fax | 817-735-4165
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Authorized Official
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Title or Position | PROVIDER
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Name | BRUCE FELTRUP-EXUM
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Credential | M.DIV., LMFT
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Telephone | 817-735-4165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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