NPIMap

Organization Active NPI

Fort Worth Psychworks, PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Fort Worth, TX
National Provider Identifier
1720775166
Registry record updated Apr 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
FORT WORTH PSYCHWORKS, PLLC
Practice address
300 College Ave
Fort Worth, TX 76104-1121
Phone
(873) 349-7646
NPI assigned
Apr 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2023

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

Authorized official

Name
Justin Gaddis, PHDNPI 1629777255
Title
Owner
Phone
(817) 349-7646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

300 College Ave
Fort Worth, TX 76104-1121

Mailing address

1704 6TH Ave
Ft Worth, TX 76110-6401
Phone (502) 775-9063

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260126000351 TX Part B Supplier - Clinic/Group Practice 2668959214 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

2120 Mistletoe Blvd
Fort Worth, TX 76110
Phone (817) 349-7646

300 College Ave
Fort Worth, TX 76104
Phone (817) 349-7646

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682208000000",
    "number": "1720775166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 6TH AVE",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761106401",
            "telephone_number": "502-775-9063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COLLEGE AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761041121",
            "telephone_number": "873-349-7646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH PSYCHWORKS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-04-23",
        "certification_date": "2023-04-23",
        "status": "A",
        "authorized_official_last_name": "GADDIS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-349-7646",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "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 Apr 23, 2023; 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.