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General NPI Number Information
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NPI Number | 1639867104
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Entity Type | Organization
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Legal Business Name | WOLF HEART COUNSELING PLLC
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 529 BLUE HAZE DR
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City | FORT WORTH
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State | TX
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Zip | 76108-3957
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Country | US
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Telephone | 817-608-7630
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Fax | 855-613-3330
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Provider Business Mailing Address
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Address Line | 529 BLUE HAZE DR
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City | FORT WORTH
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State | TX
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Zip | 76108-3957
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Country | US
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Telephone | 817-608-7630
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Fax | 855-613-3330
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | WILLIAM RUSNAK II
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Credential | MA, LPC-S
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Telephone | 817-608-7630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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