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General NPI Number Information
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NPI Number | 1427263896
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Entity Type | Organization
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Legal Business Name | MERIT FAMILY SERVICES
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 3807 E LANCASTER AVE
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City | FORT WORTH
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State | TX
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Zip | 76103-3522
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Country | US
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Telephone | 817-413-9463
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Fax | 817-471-1227
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Provider Business Mailing Address
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Address Line | 3807 E LANCASTER AVE
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City | FORT WORTH
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State | TX
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Zip | 76103-3522
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Country | US
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Telephone | 817-413-9463
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Fax | 817-427-1227
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CAROL JONES BLACKMON
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Credential |
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Telephone | 817-413-9463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2320-A
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License Number State | TX
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