Provider Demographics
NPI:1225544877
Name:FAIR WINDS ASSESSMENT AND COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:FAIR WINDS ASSESSMENT AND COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTRUP-EXUM
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, LMFT
Authorized Official - Phone:817-735-4165
Mailing Address - Street 1:6551 HARRIS PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-6103
Mailing Address - Country:US
Mailing Address - Phone:817-735-4165
Mailing Address - Fax:817-735-4165
Practice Address - Street 1:6551 HARRIS PKWY STE 240
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-6103
Practice Address - Country:US
Practice Address - Phone:817-735-4165
Practice Address - Fax:817-735-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty