| Full Circle Center | |
|
2485 E Southlake Blvd Ste 180 Southlake TX 76092-6687 | |
| (682) 593-1272 | |
| Not Available |
| Full Name | Full Circle Center |
|---|---|
| Speciality | Social Worker |
| Location | 2485 E Southlake Blvd Ste 180, Southlake, Texas |
| Authorized Official Name and Position | Nicole Siegel (OWNER, THERAPIST) |
| Authorized Official Contact | 9727546681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Circle Center 4142 Petersburg Dr Fort Worth TX 76244-4373 Ph: (972) 754-6681 | Full Circle Center 2485 E Southlake Blvd Ste 180 Southlake TX 76092-6687 Ph: (682) 593-1272 |
| NPI Number | 1578011458 |
|---|---|
| Provider Enumeration Date | 09/20/2016 |
| Last Update Date | 09/20/2016 |
| Medicare PECOS PAC ID | 1557637303 |
|---|---|
| Medicare Enrollment ID | O20171023000587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578011458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 57444 (Texas) | Primary |
| Provider Name | Nicole L Siegel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194134528 PECOS PAC ID: 5890061659 Enrollment ID: I20171023001019 |
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