=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649980186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA JOY TRIHUS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2022
-----------------------------------------------------
Last Update Date | 11/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 AIRPORT FWY STE 508
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-5358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-445-0431
-----------------------------------------------------
Fax | 214-594-9850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4909 WASHER AVE # A
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76133-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-805-9588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | 106905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 106905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------