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NPI Code Detail

MEDICARE: JUSTIN STAFFORD LPC, NCC

MEDICARE:   JUSTIN  STAFFORD  LPC, NCC
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
1101YP2500XProfessional Counselor80871TX

General Provider Information

NPI Number : 1205408051
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN STAFFORD LPC, NCC
Provider Business Mailing Address
First Line : 855 TEXAS ST STE 105
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-4574
Country : US
Telephone Number : 682-990-6242
Fax Number :
Provider Business Practice Location Address
First Line : 855 TEXAS ST STE 105
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-4574
Country : US
Telephone Number : 682-990-6242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2021
Last Update Date : 07/12/2021

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Directions to “ JUSTIN STAFFORD LPC, NCC” Practice Location

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