Provider Demographics
NPI:1598342388
Name:HERMOSA HOLISTIC COUNSELING PLLC
Entity Type:Organization
Organization Name:HERMOSA HOLISTIC COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERICKA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-258-9740
Mailing Address - Street 1:641 BAREBACK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3121
Mailing Address - Country:US
Mailing Address - Phone:682-258-9740
Mailing Address - Fax:
Practice Address - Street 1:641 BAREBACK LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-3121
Practice Address - Country:US
Practice Address - Phone:682-258-9740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659831600OtherINDIVIDUAL NPI