MEDICARE: MRS. JANICE C FEUERHELM LPC

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	61213	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61213	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1386833523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE C FEUERHELM LPC

Provider Business Mailing Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-946-5858
Fax Number	:

Provider Business Practice Location Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-946-5858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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