MEDICARE: TEXAS CARE CENTER FW SW

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
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1639021058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CARE CENTER FW SW

Provider Business Mailing Address
First Line	:	1910 PACIFIC AVE STE 5035
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4560
Country	:	US
Telephone Number	:	469-978-1930
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 PACIFIC AVE STE 5035
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4560
Country	:	US
Telephone Number	:	469-978-1930
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JERRY MOORE
Credential	:
Telephone Number	:	469-978-1930

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “TEXAS CARE CENTER FW SW ” Practice Location

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