MEDICARE: DLC CARE CLINIC IV, 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
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1992685119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DLC CARE CLINIC IV, LLC

Provider Business Mailing Address
First Line	:	5208 AIRPORT FWY STE 214
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-5922
Country	:	US
Telephone Number	:	682-499-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	5208 AIRPORT FWY STE 214
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-5922
Country	:	US
Telephone Number	:	682-499-5506
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID CHARLES
Credential	:
Telephone Number	:	682-499-5506

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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