Basic Information
| Provider Information | |||||||||
| NPI: | 1982356291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ICHO | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S., LMFT ASSOCIATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6551 HARRIS PKWY STE 240 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761326103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177354165 | ||||||||
| FaxNumber: | 8177354688 | ||||||||
| Practice Location | |||||||||
| Address1: | 6551 HARRIS PKWY STE 240 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761326103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177354165 | ||||||||
| FaxNumber: | 8177354688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2022 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 203547 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.