Southstar Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

51542 Issued in TX

Legal business name

SOUTHSTAR COUNSELING LLC

Practice address

4204 Staghorn Cir N
Fort Worth, TX 76137-1121

Phone

(817) 705-0543

Fax

(817) 386-7623

NPI assigned

Jun 18, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Carl G Cordova, LCSW

Title

President

Phone

(817) 705-0543

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339977600000",
    "number": "1487917274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2512",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761132512",
            "telephone_number": "817-705-0543",
            "fax_number": "817-386-7623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 STAGHORN CIR N",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761371121",
            "telephone_number": "817-705-0543",
            "fax_number": "817-386-7623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSTAR COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-18",
        "last_updated": "2012-06-18",
        "status": "A",
        "authorized_official_last_name": "CORDOVA",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-705-0543",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "51542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; 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.