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Organization
RESONANT EVOLUTION LLC
Active
Organization
RESONANT EVOLUTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIDA JUNE PHOENIX LPC (OWNER)
(817) 368-3875
Entity
Organization
Contact information
Practice address
440 S MAIN ST, SUITE A, FORT WORTH, TX 76104-2400
(817) 368-3875
(682) 841-1138
Mailing address
1818 S HENDERSON ST, FORT WORTH, TX 76110-6415
(817) 368-3875
(682) 841-1138
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
16923
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144980302
—
TX
Enumeration date
11/22/2013
Last updated
11/22/2013
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