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General NPI Number Information
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NPI Number | 1144373192
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Entity Type | Individual
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Provider Name | BRUCE FELTRUP-EXUM M.DIV, LMFT
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Gender | Male
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Dates
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Enumeration Date | 01/20/2007
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 6551 HARRIS PKWY STE 240
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City | FORT WORTH
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State | TX
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Zip | 76132-6103
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Country | US
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Telephone | 817-735-4165
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Fax | 817-735-4688
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Provider Business Mailing Address
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Address Line | 6551 HARRIS PKWY STE 240
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City | FORT WORTH
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State | TX
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Zip | 76132-6103
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Country | US
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Telephone | 817-735-4165
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Fax | 817-735-4688
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201097
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License Number State | TX
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