MEDICARE: TENILLE N. GANTT

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	77205	TX

General Provider Information

NPI Number	:	1588227938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENILLE N. GANTT

Provider Business Mailing Address
First Line	:	PO BOX 308
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-0308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9705 TEHAMA RIDGE PKWY STE 255
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7526
Country	:	US
Telephone Number	:	817-841-9013
Fax Number	:

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

Provider Enumeration Date	:	04/20/2019
Last Update Date	:	03/04/2025

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