Healthcare Provider Details

I. General information

NPI: 1629021282
Provider Name (Legal Business Name): MERIT FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 E LANCASTER AVE
FORT WORTH TX
76103-3522
US

IV. Provider business mailing address

3807 E LANCASTER AVE
FORT WORTH TX
76103-3522
US

V. Phone/Fax

Practice location:
  • Phone: 817-413-9463
  • Fax: 817-413-9189
Mailing address:
  • Phone: 817-413-9463
  • Fax: 817-471-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1631756-02
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1631756-03
License Number StateTX

VIII. Authorized Official

Name: MS. CAROL JONES BLACKMON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 817-413-9463