RESONANT EVOLUTION LLC NPI 1174953483

NPI Information

  • NPI: 1174953483
  • Provider Name: RESONANT EVOLUTION LLC
  • Classification: Counselor - 101Y00000X
  • Entity Type: Organization
  • Address: 440 S MAIN ST
    SUITE A
    FORT WORTH, TX
    ZIP 76104
  • Phone: (817) 368-3875

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NPI Details

RESONANT EVOLUTION LLC is a counselor in Fort Worth, TX. The provider is a provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification. RESONANT EVOLUTION LLC NPI is 1174953483. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

440 S MAIN ST
SUITE A
FORT WORTH, TX
ZIP 76104-400
Phone: (817) 368-3875
Fax: (682) 841-1138

The provider's authorized official is Vida June Phoenix .
The authorized official title is Owner and has the following contact phone number (817) 368-3875.

The enumeration date for this NPI number is 11/22/2013 and was last updated on 11/22/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101Y00000XCounselor16923TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1144980302MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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