Country Place Counseling, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

30116 Issued in TX

Legal business name

COUNTRY PLACE COUNSELING, PLLC

Practice address

4255 Bryant Irvin Rd
Suite 101
Fort Worth, TX 76109-4233

Phone

(817) 228-4855

Fax

(817) 735-9404

NPI assigned

Jun 10, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Janet L. Douglas, LCSWNPI 1316983687

Title

Owner/Member Manager

Phone

(817) 228-4855

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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

• Janet L Douglas, LCSW

  • Clinical Social Worker
  • Cleburne, TX
  • NPI 1316983687
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1598085672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4255 BRYANT IRVIN RD",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094233",
            "telephone_number": "817-228-4855",
            "fax_number": "817-735-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4255 BRYANT IRVIN RD",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094233",
            "telephone_number": "817-228-4855",
            "fax_number": "817-735-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY PLACE COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-10",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER/MEMBER MANAGER",
        "authorized_official_telephone_number": "817-228-4855",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "30116",
            "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 16, 2010; 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.