MEDICARE: ASIC COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1942988365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASIC COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2920 OAK PARK CIR STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1853
Country	:	US
Telephone Number	:	817-616-0504
Fax Number	:	817-616-0758

Provider Business Practice Location Address
First Line	:	2920 OAK PARK CIR STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1853
Country	:	US
Telephone Number	:	817-616-0504
Fax Number	:	817-616-0758

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ABRA WESSELS
Credential	:
Telephone Number	:	817-616-0504

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/06/2023

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Directions to “ASIC COUNSELING SERVICES ” Practice Location

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