MEDICARE: HOMEROOM COUNSELING: TEEN FIRST 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1972467926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMEROOM COUNSELING: TEEN FIRST THERAPY PLLC

Provider Business Mailing Address
First Line	:	2201 WOLF ST APT 3103
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-1126
Country	:	US
Telephone Number	:	208-407-9063
Fax Number	:

Provider Business Practice Location Address
First Line	:	6370 LYNDON B JOHNSON FWY STE 274
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6436
Country	:	US
Telephone Number	:	208-407-9063
Fax Number	:

Authorized Official
Title or Position	:	ADOLESCENT MENTAL HEALTH THERAPIST
Name	:	LEANNE FOELL
Credential	:	LCSW
Telephone Number	:	208-407-9063

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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