Healthcare Provider Details

I. General information

NPI: 1295277556
Provider Name (Legal Business Name): JENNIFER ZATOPEK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 HULEN ST
FORT WORTH TX
76107-7277
US

IV. Provider business mailing address

3840 HULEN ST
FORT WORTH TX
76107-7277
US

V. Phone/Fax

Practice location:
  • Phone: 817-569-4300
  • Fax:
Mailing address:
  • Phone: 817-569-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73081
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: