MEDICARE: NEW PATTERNS OF PERCEPTION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053071548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW PATTERNS OF PERCEPTION LLC

Provider Business Mailing Address
First Line	:	4217 ALTAMESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5401
Country	:	US
Telephone Number	:	972-430-6706
Fax Number	:	972-833-1006

Provider Business Practice Location Address
First Line	:	4217 ALTAMESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5401
Country	:	US
Telephone Number	:	972-430-1006
Fax Number	:	972-833-1006

Authorized Official
Title or Position	:	MANAGER
Name	:	KURT BILLUPS
Credential	:	MA, LPC, LPHA
Telephone Number	:	972-430-6706

Provider Enumeration Date	:	12/23/2021
Last Update Date	:	12/23/2021

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Directions to “NEW PATTERNS OF PERCEPTION LLC ” Practice Location

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