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General NPI Number Information
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NPI Number | 1477601607
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Entity Type | Individual
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Provider Name | KENNETH J FALLIN M.S.S.W
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 750 N FIELDER RD
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City | ARLINGTON
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State | TX
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Zip | 76012-4635
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Country | US
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Telephone | 817-253-4773
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Fax | 817-282-7738
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Provider Business Mailing Address
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Address Line | 728 SADDLEBROOK DR S
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City | BEDFORD
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State | TX
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Zip | 76021-5336
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Country | US
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Telephone | 817-253-4773
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Fax | 817-282-7738
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19238
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License Number State | TX
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