Provider Demographics
NPI:1306345475
Name:HOPE AND GROWTH CENTER PLLC
Entity type:Organization
Organization Name:HOPE AND GROWTH CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:817-313-6393
Mailing Address - Street 1:9417 SIDE SADDLE TRL
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3135
Mailing Address - Country:US
Mailing Address - Phone:817-313-6393
Mailing Address - Fax:
Practice Address - Street 1:1240 KELLER PKWY STE 202
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1630
Practice Address - Country:US
Practice Address - Phone:817-313-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508147299OtherINSURANCE