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General NPI Number Information
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NPI Number | 1699564997
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Entity Type | Individual
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Provider Name | KRISTOPHER BENJAMIN-LEE COLVIN LMSW
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Gender | Male
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1319 SUMMIT AVE
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City | FORT WORTH
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State | TX
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Zip | 76102-4431
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Country | US
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Telephone | 817-647-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 8225 CALMONT AVE APT 1013
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City | FORT WORTH
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State | TX
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Zip | 76116-3501
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Country | US
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Telephone | 979-220-6885
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 115814
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License Number State | TX
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