FORT WELLNESS, PLLC (NPI# 1285181727) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285181727 |
| Entity Type | Organization |
| Organization Name | FORT WELLNESS, PLLC |
| Practice Address |
1809 Ridgmar Blvd Fort Worth TX 76116-2018 |
| Mailing Address |
1809 Ridgmar Blvd. Fort Worth TX 76116-2018 |
| Practice Telephone | 6822324003 |
| Mailing Telephone | 6822324003 |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |
| Authorized Official Name | MR. RANE PERRY WALLACE (OWNER) |
| Authorized Official Telephone | 6822324003 |
| Authorized Official Credential | MS, LPC-INTERN, |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | CAQH | 13854416 | 01 |
| Street Address |
1809 RIDGMAR BLVD |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76116-2018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952908980 | William Michael Marshall | Pharmacist | 8600 Camp Bowie Blvd, Forth Worth, TX 76116 | 2020-10-02 |
| 1558843599 | Donnisha Bunting | In Home Supportive Care | 2901 Broadmoor, 1115, Fort Worth, TX 76116 | 2018-09-06 |
| 1588156756 | Bilal Master | Student in an Organized Health Care Education/Training Program | 3309 Riveroad Court, 2515, Ft Worth, TX 76116 | 2018-06-04 |
| 1245769728 | Randall R Williams | Physical Therapist | 6913 Camp Bowie Blvd Suite 141, Fort Worth, TX 76116 | 2017-06-08 |
| 1023543048 | 5th Avenue Grooming Lounge | Prosthetic/Orthotic Supplier | 1201 N Watson Rd., Suite 283, Arlington, TX 76116 | 2017-04-27 |
| 1831647734 | Frisco Neuro Collaborations, Pllc | Physician Assistant | 6387 Camp Bowie Blvd Ste B-640, Fort Worth, TX 76116 | 2016-09-20 |
| 1104288372 | Brown Mobile Dental Pa | Dentist | 8008 Camp Bowie W Blvd, Ste 101, Fort Worth, TX 76116 | 2016-03-25 |
| 1639553431 | Bartholomew A Akubukwe | Pharmacist | 6700 Westfree Way, Fortworth, TX 76116 | 2015-07-13 |
| 1952718868 | Brown Mobile Dental | Dentist | 8008 Camp Bowie Suite 101, Fort Worth, TX 76116 | 2014-07-14 |
| 1275949018 | Emily Sue Danner | Dentist | 6726 Camp Bowie Blvd., Fort Worth, TX 76116 | 2014-07-01 |
| Find all providers in zip 76116 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386255453 | Anita Lynne Fulmer | Counselor | 6270 Salem Cir Apt 120, Fort Worth, TX 76132-3003 | 2020-08-12 |
| 1215551031 | Leah Klyce Cothran | Counselor | 4200 S Hulen St Ste 674, Fort Worth, TX 76109-4987 | 2020-06-08 |
| 1194284885 | Sandra Wenclasky | Counselor | 3604 Winifred Dr, Fort Worth, TX 76133-2127 | 2019-03-13 |
| 1285113746 | Deirdre P Browne | Counselor | 1500 E El Paso, Fort Worth, TX 76102 | 2018-08-07 |
| 1306333562 | Joel Campos | Counselor | 4200 South Fwy Ste 210, Fort Worth, TX 76115-1400 | 2018-04-13 |
| 1750899225 | Jason King | Counselor | 9705 Polk Ave, Fort Worth, TX 76177-7379 | 2018-01-17 |
| 1598274771 | Donna Mcdonald Stout | Counselor | 3001a W 5th St, Fort Worth, TX 76107-2206 | 2017-09-20 |
| 1053831016 | Emily Rana Hanson | Counselor | 1801 N Riverside Dr, Fort Worth, TX 76111-2732 | 2017-06-21 |
| 1780125369 | Nichole Carter | Counselor | 4820 Valley Springs Trl, Fort Worth, TX 76244-5904 | 2017-03-15 |
| 1205286762 | Rane Perry Wallace | Counselor | 1509 S University Dr Ste 212, Fort Worth, TX 76107-9501 | 2016-06-15 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76116 |
Please comment or provide details below to improve the information on FORT WELLNESS, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.