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General NPI Number Information
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NPI Number | 1073135000
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Entity Type | Individual
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Provider Name | JUSTIN TALBOT LCSW
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Gender |
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 9800 HILLWOOD PKWY STE 140
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City | FORT WORTH
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State | TX
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Zip | 76177-1532
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Country | US
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Telephone | 248-436-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 1147 N 4TH ST UNIT 3F
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1572
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Country | US
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Telephone | 409-781-0094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 106866
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW142208
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License Number State | PA
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