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General NPI Number Information
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NPI Number | 1376590422
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Entity Type | Organization
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Legal Business Name | MY HEALTH MY RESOURCES OF TARRANT COUNTY
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 3840 HULEN ST
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City | FORT WORTH
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State | TX
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Zip | 76107-7277
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Country | US
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Telephone | 817-569-4395
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Fax | 817-569-4517
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Provider Business Mailing Address
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Address Line | PO BOX 2603
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City | FORT WORTH
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State | TX
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Zip | 76113-2603
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Country | US
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Telephone | 817-569-4395
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Fax | 817-569-4517
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT SUPERVISOR
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Name | MS. VICKI CAMPBELL
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Credential |
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Telephone | 817-569-5322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/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 | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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