Healthcare Provider Details

I. General information

NPI: 1558852103
Provider Name (Legal Business Name): TATIANA FELICIA MEJIA-SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TATIANA FELICIA MEJIA LCSW

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 WOODLAND PARK BLVD STE 113
ARLINGTON TX
76013-4468
US

IV. Provider business mailing address

6100 VERANDAS CIR APT 822
FORT WORTH TX
76132-4165
US

V. Phone/Fax

Practice location:
  • Phone: 682-206-8691
  • Fax:
Mailing address:
  • Phone: 817-229-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number58492
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: