NPI 1003388455

Bethany Wallace, LCSW

Practitioner Clinical Social Worker Fort Worth, TX

Practice location

Address: 4686 Bristol Trace Trl, Fort Worth, TX 76244-6947
Phone: (817) 705-1586
Mailing address: 230 Lace Ln, Burleson, TX 76028-6736

Registered specialties

Clinical Social Worker Primary

Behavioral Health & Social Service Providers Taxonomy 1041C0700X Licence 61687 (TX)

Other Social Worker providers in Texas →

Registry record

NPI: 1003388455
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 Dec 2018
Record last updated: 26 Dec 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.