Healthcare Provider Details

I. General information

NPI: 1629175781
Provider Name (Legal Business Name): ANN BARTLETT BEAL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 FM 156 SOUTH SUITE 105
HASLET TX
76052
US

IV. Provider business mailing address

1395 FM 156 SOUTH SUITE 105
HASLET TX
76052
US

V. Phone/Fax

Practice location:
  • Phone: 817-501-1638
  • Fax: 817-439-0273
Mailing address:
  • Phone: 817-501-1638
  • Fax: 817-439-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: