Healthcare Provider Details

I. General information

NPI: 1043928591
Provider Name (Legal Business Name): TORI OLMOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 RED CLIFF DR
FORT WORTH TX
76179-7651
US

IV. Provider business mailing address

6305 RED CLIFF DR
FORT WORTH TX
76179-7651
US

V. Phone/Fax

Practice location:
  • Phone: 817-929-3650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number64773
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: