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General NPI Number Information
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NPI Number | 1194085506
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Entity Type | Organization
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Legal Business Name | LAKE WORTH COUNSELING
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 4516 BOAT CLUB RD STE 106
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City | FORT WORTH
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State | TX
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Zip | 76135-7019
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Country | US
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Telephone | 682-556-9096
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Fax | 817-238-8333
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Provider Business Mailing Address
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Address Line | 4516 BOAT CLUB RD STE 106
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City | FORT WORTH
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State | TX
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Zip | 76135-7019
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Country | US
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Telephone | 682-556-9096
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Fax | 817-238-8333
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN SCHLOSSER
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Credential | LPC
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Telephone | 682-556-9096
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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 | 5110
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17834
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License Number State | TX
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