Resonant Evolution LLC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

16923 Issued in TX

Legal business name

RESONANT EVOLUTION LLC

Practice address

440 S Main St
Suite a
Fort Worth, TX 76104-2400

Phone

(817) 368-3875

Fax

(682) 841-1138

NPI assigned

Nov 22, 2013

Organization subpart

No

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

Authorized official

Name

Ms. Vida June Phoenix, LPC

Title

Owner

Phone

(817) 368-3875

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1385078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385078400000",
    "number": "1174953483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 S HENDERSON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761106415",
            "telephone_number": "817-368-3875",
            "fax_number": "682-841-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 S MAIN ST",
            "address_2": "SUITE A",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042400",
            "telephone_number": "817-368-3875",
            "fax_number": "682-841-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESONANT EVOLUTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-22",
        "last_updated": "2013-11-22",
        "status": "A",
        "authorized_official_last_name": "PHOENIX",
        "authorized_official_first_name": "VIDA",
        "authorized_official_middle_name": "JUNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-368-3875",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "TX",
            "license": "16923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144980302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.