1467539098 NPI number — MARSHA L KRAVETZ LMFT, LPC

Table of content: MARSHA L KRAVETZ LMFT, LPC (NPI 1467539098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467539098 NPI number — MARSHA L KRAVETZ LMFT, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAVETZ
Provider First Name:
MARSHA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467539098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5608 MALVEY AVE STE 306
Provider Second Line Business Mailing Address:
FORT WORTH
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76107-5162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-679-0044
Provider Business Mailing Address Fax Number:
817-737-5757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5608 MALVEY AVE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76107-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-679-0044
Provider Business Practice Location Address Fax Number:
817-361-7521
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  9540 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 4188 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124221 . This is a "SUPERIOR PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 028547001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223453 . This is a "PHCS PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00G981 . This is a "BCBSTX GRP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2219619 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1336198894 . This is a "GRP NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83360L . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10027416 . This is a "AMERIGROUP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75205167613 . This is a "PBH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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