MEDICARE: TABITHA SHAE MALER LCSW

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	1041C0700X	Clinical Social Worker	56370	TX

General Provider Information

NPI Number	:	1942864707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA SHAE MALER LCSW

Provider Business Mailing Address
First Line	:	3412 PLANTATION LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1554
Country	:	US
Telephone Number	:	254-498-6377
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 ROAD TO SIX FLAGS W STE 145
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-2600
Country	:	US
Telephone Number	:	817-459-2433
Fax Number	:

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

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	12/08/2025

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