MEDICARE: DEPRESSION CONNECTION FOR RECOVERY

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		TX

General Provider Information

NPI Number	:	1477909158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPRESSION CONNECTION FOR RECOVERY

Provider Business Mailing Address
First Line	:	3212 COLLINSWORTH ST
Second Line	:	SUITE 3A
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6580
Country	:	US
Telephone Number	:	817-810-9599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 COLLINSWORTH ST
Second Line	:	SUITE 3A
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6580
Country	:	US
Telephone Number	:	817-810-9599
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED PEER SUPPORT SPECIALIST
Name	:	MR. THOMAS ALAN HIGGS
Credential	:	C.P.S.S.
Telephone Number	:	817-810-9599

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	05/11/2016

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Directions to “DEPRESSION CONNECTION FOR RECOVERY ” Practice Location

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