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1003388455
BETHANY WALLACE
FORT WORTH, TX
NPI
1003388455
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: TX 61687)
Enumeration Date
2018-12-26
Last Update Date
2018-12-26
Business Address
Miss BETHANY WALLACE LCSW
4686 BRISTOL TRACE TRL
FORT WORTH, TX 76244-6947
Phone number: 817-705-1586
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Mailing Address
Miss BETHANY WALLACE LCSW
230 LACE LN
BURLESON, TX 76028-6736
Phone number: 817-739-1788
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