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General NPI Number Information
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NPI Number | 1821710732
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Entity Type | Organization
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Legal Business Name | WONDERLAND HEALTH PARTNERS LLC
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 302 POINDEXTER AVE
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City | CLEBURNE
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State | TX
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Zip | 76033-4424
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Country | US
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Telephone | 254-592-4476
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Fax |
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Provider Business Mailing Address
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Address Line | 3903 MELEAR DR UNIT 151284
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City | ARLINGTON
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State | TX
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Zip | 76015-4853
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSICA BARBER
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Credential |
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Telephone | 254-592-4476
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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 |
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License Number State |
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