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General NPI Number Information
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NPI Number | 1700170610
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Entity Type | Organization
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Legal Business Name | FUERZA DE LOS CHICANOS
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 08/14/2011
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Provider Practice Location Address
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Address Line | 623 W MAIN ST SUITE 316
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City | ARLINGTON
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State | TX
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Zip | 76010-1047
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Country | US
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Telephone | 817-504-4270
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Fax |
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Provider Business Mailing Address
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Address Line | 623 W MAIN ST SUITE 316
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City | ARLINGTON
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State | TX
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Zip | 76010-1047
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Country | US
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Telephone | 817-504-4270
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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 | MR. JOSE ANTONIO GONZALES
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Credential | LMSW
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Telephone | 817-504-4270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 27167
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License Number State | TX
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