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1992255129
MIRANDA KELLY
FORT WORTH, TX
NPI
1992255129
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: TX 56207)
Enumeration Date
2016-10-12
Last Update Date
2016-10-12
Business Address
-- MIRANDA KELLY
1518 E LANCASTER AVE
FORT WORTH, TX 76102-6774
Phone number: 817-255-7150
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Mailing Address
-- MIRANDA KELLY
1518 E LANCASTER AVE
FORT WORTH, TX 76102-6774
Phone number:
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