Provider Demographics
NPI:1386439016
Name:360 SUPPORT SOLUTIONS LLC
Entity type:Organization
Organization Name:360 SUPPORT SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTIONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-791-5609
Mailing Address - Street 1:601 UNIVERSITY DR STE 112
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2170
Mailing Address - Country:US
Mailing Address - Phone:817-791-5609
Mailing Address - Fax:817-818-1821
Practice Address - Street 1:601 UNIVERSITY DR STE 112
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2170
Practice Address - Country:US
Practice Address - Phone:817-791-5609
Practice Address - Fax:817-818-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-12
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)