MEDICARE: CHRISTINE MICHELLE MOGAN LPC-A

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	101Y00000X	Counselor	101760	TX

General Provider Information

NPI Number	:	1619810918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MICHELLE MOGAN LPC-A

Provider Business Mailing Address
First Line	:	6100 BULLHEAD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-7574
Country	:	US
Telephone Number	:	214-334-6508
Fax Number	:

Provider Business Practice Location Address
First Line	:	3348 PEDEN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-5508
Country	:	US
Telephone Number	:	214-334-6508
Fax Number	:

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

Provider Enumeration Date	:	04/11/2026
Last Update Date	:	04/11/2026

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Directions to “ CHRISTINE MICHELLE MOGAN LPC-A” Practice Location

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