MEDICARE: IRONWOOD THERAPEUTIC WELLNESS, 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
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1578367991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRONWOOD THERAPEUTIC WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	9104 BRONZE MEADOW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1815
Country	:	US
Telephone Number	:	214-699-8026
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 FM 156 N
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-3007
Country	:	US
Telephone Number	:	214-699-8026
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KAILEE RUBRIGHT
Credential	:	LCSW
Telephone Number	:	214-699-8026

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	05/20/2025

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