Provider Demographics
NPI:1578011458
Name:FULL CIRCLE THERAPY CENTER, PLLC
Entity Type:Organization
Organization Name:FULL CIRCLE THERAPY CENTER, PLLC
Other - Org Name:FULL CIRCLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC
Authorized Official - Phone:972-754-6681
Mailing Address - Street 1:4142 PETERSBURG DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4373
Mailing Address - Country:US
Mailing Address - Phone:972-754-6681
Mailing Address - Fax:
Practice Address - Street 1:2485 E SOUTHLAKE BLVD STE 180
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6687
Practice Address - Country:US
Practice Address - Phone:682-593-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX574441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty