Provider Demographics
NPI:1831557636
Name:MOSSHILL DISCOVERY CENTER PLLC
Entity type:Organization
Organization Name:MOSSHILL DISCOVERY CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WEND
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-301-7374
Mailing Address - Street 1:3001 W 5TH ST STE 800
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-8909
Mailing Address - Country:US
Mailing Address - Phone:817-301-7374
Mailing Address - Fax:
Practice Address - Street 1:3001 W 5TH ST STE 800
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-8909
Practice Address - Country:US
Practice Address - Phone:817-301-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72380251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health