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General NPI Number Information
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NPI Number | 1467539098
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Entity Type | Individual
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Provider Name | MARSHA L KRAVETZ LMFT, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 5608 MALVEY AVE SUITE 306
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City | FORT WORTH
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State | TX
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Zip | 76107-5100
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Country | US
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Telephone | 817-679-0044
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Fax | 817-361-7521
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Provider Business Mailing Address
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Address Line | 5608 MALVEY AVE STE 306 FORT WORTH
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City | FORT WORTH
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State | TX
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Zip | 76107-5162
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Country | US
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Telephone | 817-679-0044
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Fax | 817-737-5757
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 9540
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4188
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License Number State | TX
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