MEDICARE: JDK COUNSELING SERVICES LLC

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	101YP2500X	Professional Counselor	65775	TX

General Provider Information

NPI Number	:	1912250309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JDK COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	7833 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4231
Country	:	US
Telephone Number	:	817-944-0064
Fax Number	:	817-370-8977

Provider Business Practice Location Address
First Line	:	7833 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4231
Country	:	US
Telephone Number	:	817-944-0064
Fax Number	:	817-370-8977

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	JOAN KERLEY
Credential	:	LPC
Telephone Number	:	817-944-0064

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	10/22/2012

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