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General NPI Number Information
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NPI Number | 1740412204
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Entity Type | Organization
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Legal Business Name | OAKMONT COUNSELING CENTER
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 7833 OAKMONT BLVD # 110
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City | FORT WORTH
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State | TX
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Zip | 76132-4231
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Country | US
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Telephone | 817-665-0583
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Fax | 817-370-8977
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Provider Business Mailing Address
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Address Line | 7833 OAKMONT BLVD. # 110
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City | FORT WORTH
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State | TX
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Zip | 76132
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Country | US
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Telephone | 817-665-0583
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Fax | 817-370-8977
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Authorized Official
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Title or Position | OWNER
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Name | JERRI L PEDRO
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Credential | NCC, LPC, RPT
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Telephone | 817-665-0583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 209525
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 62483
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License Number State | TX
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