MEDICARE: CHELSEA R JAUBERT MS IN MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	205800	TX

General Provider Information

NPI Number	:	1003624966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA R JAUBERT MS IN MFT

Provider Business Mailing Address
First Line	:	PO BOX 16243
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76162-0243
Country	:	US
Telephone Number	:	817-773-8326
Fax Number	:

Provider Business Practice Location Address
First Line	:	4404 STEPPING STONE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1868
Country	:	US
Telephone Number	:	817-773-8326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2024
Last Update Date	:	12/24/2024

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