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General NPI Number Information
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NPI Number | 1861170839
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Entity Type | Organization
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Legal Business Name | INTIMACY COUNSELING & CONSULTING
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 3900 MERRETT DR STE C
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City | FORT WORTH
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State | TX
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Zip | 76135-2920
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Country | US
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Telephone | 903-466-2643
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Fax |
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Provider Business Mailing Address
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Address Line | 4553 GLENVIEW CT
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-7349
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Country | US
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Telephone | 903-466-2643
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | FEDERICO MENDEZ
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Credential | LMFT
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Telephone | 817-631-9991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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