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General NPI Number Information
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NPI Number | 1558574665
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Entity Type | Individual
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Provider Name | DOROTHY G ST JOHN LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4200 S HULEN ST STE 682
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City | FORT WORTH
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State | TX
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Zip | 76109-7905
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Country | US
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Telephone | 817-569-9514
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Fax | 817-926-2656
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Provider Business Mailing Address
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Address Line | 3808 WEYBURN DR
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City | FORT WORTH
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State | TX
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Zip | 76109-5218
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Country | US
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Telephone | 817-926-7942
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Fax | 817-926-2656
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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 | LCSW 1766
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License Number State | TX
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