Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 15398 | TX |
NPI | 1003190869 |
---|---|
Provider Name | Felice Mayes |
First Address | Fort Worth, TX 76107-2242 |
Second Address | Fort Worth, TX 76107-2242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2011 |
Last Update Date | 28/09/2011 |