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NPI Code Detail

MEDICARE: JUDITH PRESLEY LCDC

MEDICARE: JUDITH PRESLEY LCDC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorTX
2101YA0400XAddiction (Substance Use Disorder) Counselor14736TX

General Provider Information

NPI Number : 1548852148
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH PRESLEY LCDC
Provider Business Mailing Address
First Line : 4801 BRENTWOOD STAIR RD STE 404
Second Line :
City : FORT WORTH
State : TX
Zip : 76103-1731
Country : US
Telephone Number : 817-492-9383
Fax Number :
Provider Business Practice Location Address
First Line : 4801 BRENTWOOD STAIR RD STE 404
Second Line :
City : FORT WORTH
State : TX
Zip : 76103-1731
Country : US
Telephone Number : 817-492-9383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2021
Last Update Date : 02/05/2021

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Directions to “ JUDITH PRESLEY LCDC” Practice Location

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