1902955727 NPI number — MRS. MARY B ABLETT LCSW

Table of content: MRS. MARY B ABLETT LCSW (NPI 1902955727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902955727 NPI number — MRS. MARY B ABLETT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABLETT
Provider First Name:
MARY
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABLETT
Provider Other First Name:
MARY
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902955727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
183 FOREST BEND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEATHERFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76087-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-598-0345
Provider Business Mailing Address Fax Number:
817-598-9169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7833 OAKMONT BLVD
Provider Second Line Business Practice Location Address:
110
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76132-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-665-0583
Provider Business Practice Location Address Fax Number:
817-370-8977
Provider Enumeration Date:
01/10/2007

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: 1041C0700X , with the licence number:  39014 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 87618Q . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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