Provider Demographics
NPI:1134706120
Name:THERAPY FORT WORTH AND COUNSELING CENTER
Entity type:Organization
Organization Name:THERAPY FORT WORTH AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAILY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-231-2319
Mailing Address - Street 1:1751 RIVER RUN STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6670
Mailing Address - Country:US
Mailing Address - Phone:682-231-2319
Mailing Address - Fax:
Practice Address - Street 1:1751 RIVER RUN STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6670
Practice Address - Country:US
Practice Address - Phone:682-231-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty