MEDICARE: DITCH THE LIE COUNSELING

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1386125128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DITCH THE LIE COUNSELING

Provider Business Mailing Address
First Line	:	9200 CHRISTOPHER CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-5157
Country	:	US
Telephone Number	:	817-996-8517
Fax Number	:

Provider Business Practice Location Address
First Line	:	4818 BERKMAN DR APT 4121
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-1260
Country	:	US
Telephone Number	:	817-996-8517
Fax Number	:	844-354-0975

Authorized Official
Title or Position	:	MANAGER
Name	:	GAY A HUNTER
Credential	:	M.DIV.,LPC-S
Telephone Number	:	817-996-8517

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	04/17/2020

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Directions to “DITCH THE LIE COUNSELING ” Practice Location

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