MEDICARE: MICHELE D GORTNEY L.P.C.S.

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	19940	TX
2	101YP2500X	Professional Counselor	19940	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88602L	OTHER	TX	BLUECROSSBLUESHIELD PROV#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659541092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE D GORTNEY L.P.C.S.

Provider Business Mailing Address
First Line	:	PO BOX 2603
Second Line	:	HTN, CLIENT ACCOUNTING
City	:	FORT WORTH
State	:	TX
Zip	:	76113-2603
Country	:	US
Telephone Number	:	817-569-4396
Fax Number	:	817-569-4517

Provider Business Practice Location Address
First Line	:	240 E RENFRO ST STE 201
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-3940
Country	:	US
Telephone Number	:	817-913-1517
Fax Number	:

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

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	12/09/2025

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Directions to “ MICHELE D GORTNEY L.P.C.S.” Practice Location

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