MEDICARE: ANU COUNSELING & SUPPORTIVE SERVICES, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1114819752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANU COUNSELING & SUPPORTIVE SERVICES, PLLC

Provider Business Mailing Address
First Line	:	3000 S HULEN ST STE 124-936
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1914
Country	:	US
Telephone Number	:	469-986-4992
Fax Number	:	469-589-3639

Provider Business Practice Location Address
First Line	:	3000 S HULEN ST STE 124-936
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1914
Country	:	US
Telephone Number	:	469-986-4992
Fax Number	:	469-589-3639

Authorized Official
Title or Position	:	OWNER
Name	:	KRYSTLE RENE'E BORDLEY
Credential	:
Telephone Number	:	469-986-4992

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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