MEDICARE: MRS. JENNIFER ANNE GOTCHER M.S. LMFT

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	106H00000X	Marriage & Family Therapist		OK
2	106H00000X	Marriage & Family Therapist	201288	TX

General Provider Information

NPI Number	:	1831395110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANNE GOTCHER M.S. LMFT

Provider Business Mailing Address
First Line	:	2832 RYAN PLACE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110
Country	:	US
Telephone Number	:	817-773-5925
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 HULEN ST BLDG B
Second Line	:	SUITE 4
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6863
Country	:	US
Telephone Number	:	817-773-5925
Fax Number	:

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	03/17/2011

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