MEDICARE: HOPE STARTS HERE WELLNESS CENTER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1487344479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE STARTS HERE WELLNESS CENTER

Provider Business Mailing Address
First Line	:	6075 MONTE VISTA LN APT 1621
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-5436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6075 MONTE VISTA LN APT 1621
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-5436
Country	:	US
Telephone Number	:	512-975-9547
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. EDWARD TOWNS
Credential	:	LPC
Telephone Number	:	512-975-9547

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	05/11/2023

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