MEDICARE: TRUTHTRIBE 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

General Provider Information

NPI Number	:	1235746660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUTHTRIBE LLC

Provider Business Mailing Address
First Line	:	637 W 18TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3609
Country	:	US
Telephone Number	:	713-352-7789
Fax Number	:

Provider Business Practice Location Address
First Line	:	637 W 18TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3609
Country	:	US
Telephone Number	:	713-352-7789
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	JILL AHRENS TUCKER
Credential	:	LPC-S
Telephone Number	:	713-352-7789

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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Directions to “TRUTHTRIBE LLC ” Practice Location

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