=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659043172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATASHA VARNER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2021
-----------------------------------------------------
Last Update Date | 05/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 929 NEWBERRY TRAIL
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-320-5852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 729 GRAPEVINE HWY UNIT 3035
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76054-2805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-998-1617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 82962
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------