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General NPI Number Information
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NPI Number | 1699646091
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Entity Type | Organization
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Legal Business Name | WELL COUNSELING GROUP
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 1617 PARK PLACE AVE STE 110
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City | FORT WORTH
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State | TX
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Zip | 76110-1300
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Country | US
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Telephone | 940-226-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 1617 PARK PLACE AVE STE 110
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City | FORT WORTH
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State | TX
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Zip | 76110-1300
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Country | US
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Telephone | 940-226-1711
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Fax |
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Authorized Official
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Title or Position | CEO, OWNER, DIRECTOR
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Name | OLIVIA TIDWELL
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Credential | MS, LPC
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Telephone | 940-226-1711
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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 |
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License Number State |
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