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General NPI Number Information
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NPI Number | 1417433749
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Entity Type | Organization
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Legal Business Name | STAFFORD HEALING CONSULTANTS, LLC
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 3109 6TH AVE STE B
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City | FORT WORTH
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State | TX
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Zip | 76110-3800
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Country | US
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Telephone | 214-674-0798
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Fax | 682-312-8313
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Provider Business Mailing Address
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Address Line | 3359 CROMART AVE
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City | FORT WORTH
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State | TX
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Zip | 76133-1439
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Country | US
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Telephone | 214-674-0798
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ASHLEY ELIZABETH STAFFORD
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Credential | LCSW
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Telephone | 214-674-0798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 63341
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License Number State | TX
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