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General NPI Number Information
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NPI Number | 1689088569
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Entity Type | Organization
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Legal Business Name | HEARTS FOUNDATION INC
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 6300 JOHN RYAN DR
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City | FORT WORTH
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State | TX
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Zip | 76132-4122
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Country | US
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Telephone | 310-995-7427
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 JOHN RYAN DR
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City | FORT WORTH
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State | TX
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Zip | 76132-4122
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Country | US
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Telephone | 310-995-7427
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. BEATIX SIBYLLE WAGNER
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Credential | PYS.D.
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Telephone | 310-995-7427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY23746
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 36904
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License Number State | TX
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