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2102 Dorsey Dr Forney TX 75126-0925 | |
| (469) 249-3585 | |
| (469) 249-3585 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2102 Dorsey Dr, Forney, Texas |
| Authorized Official Name and Position | Jennifer Lee Boatright (PRESIDENT) |
| Authorized Official Contact | 4692492585 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1350 Forney TX 75126-1350 Ph: (972) 521-6105 | 2102 Dorsey Dr Forney TX 75126-0925 Ph: (469) 249-3585 |
| NPI Number | 1720608540 |
|---|---|
| Provider Enumeration Date | 04/22/2020 |
| Last Update Date | 09/30/2020 |
| Certification Date | 09/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720608540 | NPI | - | NPPES |
| 410883901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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