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General NPI Number Information
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NPI Number | 1881008126
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Entity Type | Organization
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Legal Business Name | MARY DAINTY, M.A., LPC-S
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Dates
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Enumeration Date | 06/14/2014
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 1810 8TH AVE SUITE B204, 2ND FLOOR
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City | FORT WORTH
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State | TX
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Zip | 76110-1352
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Country | US
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Telephone | 682-235-3401
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Fax | 413-208-3830
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Provider Business Mailing Address
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Address Line | 1810 8TH AVE SUITE B204, 2ND FLOOR
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City | FORT WORTH
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State | TX
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Zip | 76110-1352
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Country | US
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Telephone | 682-235-3401
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Fax | 413-208-3830
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Authorized Official
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Title or Position | COUNSELOR SUPERVISOR
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Name | MARY DAINTY
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Credential | LPC-S
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Telephone | 682-235-3401
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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 | 18640
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License Number State | TX
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