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General NPI Number Information
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NPI Number | 1225311681
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Entity Type | Organization
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Legal Business Name | TCMERF
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 900 SOUTHLAND AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3911
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Country | US
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Telephone | 817-336-5454
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Fax | 817-336-4026
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Provider Business Mailing Address
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Address Line | 900 SOUTHLAND AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3911
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Country | US
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Telephone | 817-336-5454
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Fax | 817-336-4026
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. LEE M. ROBINSON
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Credential | MAMFC MACE
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Telephone | 817-336-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0000007
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License Number State | TX
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