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NPI Code Detail

MEDICARE: TERRA THERAPIES, PLLC

MEDICARE: TERRA THERAPIES, PLLC
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
1101YP2500XProfessional Counselor66955TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11649515198OTHERTXINSURANCE PANELS

General Provider Information

NPI Number : 1457844953
Entity Type Code : Organization
Provider Name (Legal Business Name) : TERRA THERAPIES, PLLC
Provider Business Mailing Address
First Line : 4113 MARKS PL
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-7900
Country : US
Telephone Number : 817-907-0022
Fax Number : 817-945-1456
Provider Business Practice Location Address
First Line : 1706 ENDERLY PL
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4122
Country : US
Telephone Number : 817-907-0022
Fax Number : 817-945-1456
Authorized Official
Title or Position : BUSINESS OWNER
Name : COURTNEY J GUHL
Credential : LPC
Telephone Number : 817-907-0022
Provider Enumeration Date : 06/08/2018
Last Update Date : 06/08/2018

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Directions to “TERRA THERAPIES, PLLC ” Practice Location

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