Intrinsic Counseling and Treatment Center, PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

INTRINSIC COUNSELING AND TREATMENT CENTER, PLLC

Practice address

16516 Porterfield Lane
Fort Worth, TX 76247-7624

Phone

(682) 231-1132

NPI assigned

Jul 25, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Wade Christian Peterson, MA, LPC, NCCNPI 1447897806

Title

Ceo

Phone

(682) 231-1132

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wade Christian Peterson, MA, LPC, NCC

  • Mental Health Counselor
  • Dallas, TX
  • NPI 1447897806
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1013643857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16516 PORTERFIELD LANE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16516 PORTERFIELD LANE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762477624",
            "telephone_number": "682-231-1132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTRINSIC COUNSELING AND TREATMENT CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-25",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "CHRISTIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "682-231-1132",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.