MEDICARE: MY HEALTH MY RESOURCES OF TARRANT COUNTY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QD1600X	Developmental Disabilities Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
6	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
7	324500000X	Substance Abuse Rehabilitation Facility
8	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376590422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY HEALTH MY RESOURCES OF TARRANT COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 2603
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76113-2603
Country	:	US
Telephone Number	:	817-569-4395
Fax Number	:	817-569-4517

Provider Business Practice Location Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4395
Fax Number	:	817-569-4517

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT SUPERVISOR
Name	:	MS. VICKI CAMPBELL
Credential	:
Telephone Number	:	817-569-5322

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/12/2025

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