MEDICARE: WCHS OF TEXAS

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	0000082	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000082	OTHER	TX	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1801933361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WCHS OF TEXAS

Provider Business Mailing Address
First Line	:	700 HEMPHILL ST STE A
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3105
Country	:	US
Telephone Number	:	817-334-0111
Fax Number	:	817-334-0249

Provider Business Practice Location Address
First Line	:	700 HEMPHILL STREET, STE A
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3105
Country	:	US
Telephone Number	:	918-334-0111
Fax Number	:	817-334-0249

Authorized Official
Title or Position	:	OTP DIVISION PRESIDENT
Name	:	MR. PHIL HERSCHMAN
Credential	:
Telephone Number	:	760-918-8700

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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Directions to “WCHS OF TEXAS ” Practice Location

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