MEDICARE: INTENTIONAL THERAPY, PLLC

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

General Provider Information

NPI Number	:	1841943297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTENTIONAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	3100 DISCOVERY DR
Second Line	:
City	:	OAK POINT
State	:	TX
Zip	:	75068-1687
Country	:	US
Telephone Number	:	210-816-1488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 QUEENSDOWN WAY
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-3579
Country	:	US
Telephone Number	:	214-506-8094
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LICENSED PROFESSIONAL COUNSEL
Name	:	PARTHI BAKUL PATEL
Credential	:	LPC
Telephone Number	:	210-816-1488

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	03/19/2024

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