Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 12362 | TX |
NPI | 1003210113 |
---|---|
Provider Name | Jessica Batts |
First Address | Fort Worth, TX 76112-2384 |
Second Address | Fort Worth, TX 76112-2384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2014 |
Last Update Date | 14/12/2015 |