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General NPI Number Information
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NPI Number | 1588076764
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Entity Type | Organization
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Legal Business Name | MODLIN DEVELOPMENT RESOURCES PLLC
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 5751 KROGER DR STE 237
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City | FORT WORTH
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State | TX
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Zip | 76244-5649
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Country | US
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Telephone | 817-631-3316
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Fax |
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Provider Business Mailing Address
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Address Line | 5751 KROGER DR STE 237
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City | FORT WORTH
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State | TX
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Zip | 76244-5649
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Country | US
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Telephone | 817-631-3316
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. COLE L MODLIN
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Credential | MA, LPC,
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Telephone | 817-631-3316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 68664
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License Number State | TX
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