MEDICARE: SARAH RYAN WELLBORN LCSW

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
1	1041C0700X	Clinical Social Worker	56816	TX

General Provider Information

NPI Number	:	1225577471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RYAN WELLBORN LCSW

Provider Business Mailing Address
First Line	:	4200 S HULEN ST STE 678
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-7902
Country	:	US
Telephone Number	:	817-203-4779
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 S HULEN ST STE 678
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-7902
Country	:	US
Telephone Number	:	817-203-4779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	10/09/2024

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