Healthcare Provider Details

I. General information

NPI: 1518278225
Provider Name (Legal Business Name): TERESA LYNN SAWYER LCDC, ADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 JOHN T WHITE RD
FORT WORTH TX
76120-3311
US

IV. Provider business mailing address

7525 JOHN T WHITE RD
FORT WORTH TX
76120-3311
US

V. Phone/Fax

Practice location:
  • Phone: 817-689-3510
  • Fax: 817-457-7906
Mailing address:
  • Phone: 817-689-3510
  • Fax: 817-457-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8768
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: