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Organization
FORT WELLNESS, PLLC
Active
Organization
FORT WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANE PERRY WALLACE MS, LPC-INTERN, LCDC (OWNER)
(682) 232-4003
Entity
Organization
Contact information
Practice address
1809 RIDGMAR BLVD, FORT WORTH, TX 76116-2018
(682) 232-4003
Mailing address
1809 RIDGMAR BLVD., FORT WORTH, TX 76116-2018
(682) 232-4003
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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