MEDICARE: PROJECT-44

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376787093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT-44

Provider Business Mailing Address
First Line	:	2416 W BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-2818
Country	:	US
Telephone Number	:	817-313-6916
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 W BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-2818
Country	:	US
Telephone Number	:	817-313-6916
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MARGRET LINDA FIELDS
Credential	:	LPC
Telephone Number	:	817-313-6916

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	04/24/2009

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