Provider Information for 1043642127
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Mrs. CIARA L WEDDBORN LPC intern
Sex: Female
NPI: 1043642127
Last Updated: 2013-07-31
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1043642127 | ||||||||
| Enumeration Date | 2013-07-31 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 111 NW 24TH ST FORT WORTH, TX 76164-8544 United States Phone: 817-626-6401 | Fax:817-626-6400 | ||||||||
| Primary Practice Address | 111 NW 24TH ST FORT WORTH, TX 76164-8544 United States Phone: 817-626-6401 | Fax:817-626-6400 | ||||||||
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