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General NPI Number Information
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NPI Number | 1417295445
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Entity Type | Organization
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Legal Business Name | FORT WORTH BRIEF THERAPY CENTER, PLLC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 3113 S UNIVERSITY DR STE 201
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City | FT WORTH
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State | TX
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Zip | 76109-5616
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Country | US
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Telephone | 817-923-1444
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Fax | 817-923-1490
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Provider Business Mailing Address
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Address Line | 800 US HIGHWAY 287 SUITE 1
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City | RHOME
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State | TX
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Zip | 76078-4323
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Country | US
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Telephone | 817-301-6322
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Fax | 817-923-1490
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. MATHEW A. TRAMMELL
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Credential | LPC-S
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Telephone | 817-301-6322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 62762
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License Number State | TX
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