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General NPI Number Information
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NPI Number | 1477191385
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Entity Type | Organization
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Legal Business Name | CANARY RIDGE COUNSELING PLLC
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 2501 PARKVIEW DR STE 316E
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City | FORT WORTH
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State | TX
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Zip | 76102-5824
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Country | US
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Telephone | 817-692-5467
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 PARKVIEW DR STE 316E
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City | FORT WORTH
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State | TX
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Zip | 76102-5824
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER BEAMAN
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Credential | LPC
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Telephone | 817-692-5467
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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 |
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License Number State |
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