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General NPI Number Information
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NPI Number | 1568144723
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Entity Type | Organization
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Legal Business Name | CANVAS OUTPATIENT, PLLC
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 5521 BELLAIRE DR S STE 114
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City | FORT WORTH
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State | TX
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Zip | 76109-5855
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Country | US
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Telephone | 817-394-2346
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Fax | 817-520-8520
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Provider Business Mailing Address
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Address Line | 5521 BELLAIRE DR S STE 114
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City | FORT WORTH
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State | TX
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Zip | 76109-5855
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Country | US
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Telephone | 817-394-2346
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Fax | 817-520-8520
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. ASHLEY STAFFORD
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Credential | LCSW-S
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Telephone | 214-674-0798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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