| Texas Lpc Supervision | |
|
1810 8th Ave Suite B204, 2nd Floor Fort Worth TX 76110-1352 | |
| (682) 235-3401 | |
| (413) 208-3830 |
| Full Name | Texas Lpc Supervision |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1810 8th Ave, Fort Worth, Texas |
| Authorized Official Name and Position | Mary Dainty (COUNSELOR SUPERVISOR) |
| Authorized Official Contact | 6822353401 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Texas Lpc Supervision 1810 8th Ave Suite B204, 2nd Floor Fort Worth TX 76110-1352 Ph: (682) 235-3401 | Texas Lpc Supervision 1810 8th Ave Suite B204, 2nd Floor Fort Worth TX 76110-1352 Ph: (682) 235-3401 |
| NPI Number | 1881008126 |
|---|---|
| Provider Enumeration Date | 06/14/2014 |
| Last Update Date | 04/02/2021 |
| Certification Date | 04/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881008126 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 18640 (Texas) | Primary |
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