NPIMap

Organization Active NPI

Resonant Evolution LLC

  • Counselor
  • Fort Worth, TX
National Provider Identifier
1174953483
Registry record updated Nov 22, 2013
On this page

Key facts

NPPES NPI Registry
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
Last updated
Nov 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2013

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

Authorized official

Name
Ms. Vida June Phoenix, LPCNPI 1962607812
Title
Owner
Phone
(817) 368-3875

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101Y00000X 16923 TX Primary

Addresses

Primary practice location

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

Mailing address

1818 S Henderson St
Fort Worth, TX 76110-6415
Phone (817) 368-3875

National Provider Directory

National Provider Directory

Locations

440 S Main St
Ste A
Fort Worth, TX 76104
Phone (817) 368-3875

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • 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.