=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548074362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COWTOWN THERAPY CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2025
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 844 PENNSYLVANIA AVE STE 220
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-231-2577
-----------------------------------------------------
Fax | 682-292-7535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6387 CAMP BOWIE BLVD, STE B, PMB 303
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-231-2577
-----------------------------------------------------
Fax | 682-292-7535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KINLEY NOELLE SPRINGS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 682-231-2577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------