MEDICARE: MRS. ALISON LEE FESCENMEYER

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	101Y00000X	Counselor	73571	TX

General Provider Information

NPI Number	:	1811437262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISON LEE FESCENMEYER

Provider Business Mailing Address
First Line	:	3706 W BIDDISON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2705
Country	:	US
Telephone Number	:	817-798-5243
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 MERCANTILE PLAZA DR
Second Line	:	SUITE 307
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4225
Country	:	US
Telephone Number	:	817-798-5243
Fax Number	:

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

Provider Enumeration Date	:	03/05/2017
Last Update Date	:	03/05/2017

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