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NPI Code Detail

MEDICARE: HOPE CENTER 4 AUTISM FORT WORTH

MEDICARE: HOPE CENTER 4 AUTISM FORT WORTH
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
1103K00000XBehavior Analyst1063185TX

General Provider Information

NPI Number : 1629386156
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPE CENTER 4 AUTISM FORT WORTH
Provider Business Mailing Address
First Line : 2751 GREEN OAKS RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-1706
Country : US
Telephone Number : 817-560-1139
Fax Number : 817-560-7039
Provider Business Practice Location Address
First Line : 2751 GREEN OAKS RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-1706
Country : US
Telephone Number : 817-560-1139
Fax Number : 817-560-7039
Authorized Official
Title or Position : DIRECTOR
Name : MRS. SUSAN LANETTE WOOD
Credential :
Telephone Number : 817-560-1109
Provider Enumeration Date : 09/17/2010
Last Update Date : 11/30/2010

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Directions to “HOPE CENTER 4 AUTISM FORT WORTH ” Practice Location

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