Healthcare Provider Details

I. General information

NPI: 1215823018
Provider Name (Legal Business Name): KAY MAGEE LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 BRENTWOOD STAIR RD STE 404
FT WORTH TX
76103-1731
US

IV. Provider business mailing address

4801 BRENTWOOD STAIR RD STE 404
FT WORTH TX
76103-1731
US

V. Phone/Fax

Practice location:
  • Phone: 817-492-9383
  • Fax: 817-492-9575
Mailing address:
  • Phone: 817-492-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17366
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: