| Rejected & Restored | |
|
6764 Dandelion Dr Fort Worth TX 76137-2372 | |
| (570) 974-7201 | |
| Not Available |
| Full Name | Rejected & Restored |
|---|---|
| Speciality | Counselor - Professional |
| Location | 6764 Dandelion Dr, Fort Worth, Texas |
| Authorized Official Name and Position | Kimberly Jones-searcy (OWNER) |
| Authorized Official Contact | 5709747201 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rejected & Restored 6764 Dandelion Dr Fort Worth TX 76137-2372 Ph: () - | Rejected & Restored 6764 Dandelion Dr Fort Worth TX 76137-2372 Ph: (570) 974-7201 |
| NPI Number | 1740928167 |
|---|---|
| Provider Enumeration Date | 05/25/2022 |
| Last Update Date | 05/25/2022 |
| Certification Date | 05/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740928167 | NPI | - | NPPES |
| 83095 | Other | TX | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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