1659531663 NPI number — MRS. BRENDA WINGO HROVAT M.ED., LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659531663 NPI number — MRS. BRENDA WINGO HROVAT M.ED., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HROVAT
Provider First Name:
BRENDA
Provider Middle Name:
WINGO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINGO
Provider Other First Name:
BRENDA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED, LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659531663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 N. BEACH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-916-5217
Provider Business Mailing Address Fax Number:
817-916-4665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 W ROSEDALE ST
Provider Second Line Business Practice Location Address:
SUITE 518
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-7438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-348-8351
Provider Business Practice Location Address Fax Number:
817-348-8355
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  10736 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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