MEDICARE: COVENANT KIDS INC

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	251B00000X	Case Management Agency
2	103TC2200X	Clinical Child & Adolescent Psychologist	32661	TX
3	101YP2500X	Professional Counselor	59857	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861606113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT KIDS INC

Provider Business Mailing Address
First Line	:	PO BOX 173038
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76003-3038
Country	:	US
Telephone Number	:	817-516-9100
Fax Number	:	817-516-9102

Provider Business Practice Location Address
First Line	:	201 N RUPERT ST STE 133
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-1465
Country	:	US
Telephone Number	:	817-516-9100
Fax Number	:	817-516-9102

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR
Name	:	LORIE GIBSON
Credential	:
Telephone Number	:	817-516-9100

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	03/11/2026

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Directions to “COVENANT KIDS INC ” Practice Location

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