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General NPI Number Information
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NPI Number | 1386439016
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Entity Type | Organization
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Legal Business Name | 360 SUPPORT SOLUTIONS LLC
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 601 UNIVERSITY DR STE 112
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City | FORT WORTH
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State | TX
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Zip | 76107-2170
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Country | US
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Telephone | 817-791-5609
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Fax | 817-818-1821
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Provider Business Mailing Address
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Address Line | 601 UNIVERSITY DR STE 112
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City | FORT WORTH
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State | TX
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Zip | 76107-2170
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Country | US
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Telephone | 817-952-6956
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Fax | 817-818-1821
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANTIONETTE FOSTER
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Credential | LPC
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Telephone | 817-952-6956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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