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NPI Code Detail

MEDICARE: MR. WESLEY MARTIN RAGLE LMSW

MEDICARE: MR. WESLEY MARTIN RAGLE LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker40381TX

General Provider Information

NPI Number : 1184779662
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WESLEY MARTIN RAGLE LMSW
Provider Business Mailing Address
First Line : 1220 W PRESIDIO ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-4512
Country : US
Telephone Number : 817-335-6429
Fax Number :
Provider Business Practice Location Address
First Line : 1220 W PRESIDIO ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-4512
Country : US
Telephone Number : 817-335-6429
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/02/2021

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