Provider Demographics
NPI:1659531663
Name:HROVAT, BRENDA WINGO (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:WINGO
Last Name:HROVAT
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:KAY
Other - Last Name:WINGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:400 N. BEACH
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111
Mailing Address - Country:US
Mailing Address - Phone:817-916-5217
Mailing Address - Fax:817-916-4665
Practice Address - Street 1:1550 W ROSEDALE ST
Practice Address - Street 2:SUITE 518
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7438
Practice Address - Country:US
Practice Address - Phone:817-348-8351
Practice Address - Fax:817-348-8355
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional