# 22KILL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811524085
- **Authorized official:** MRS. TEMPA SHERRILL (COO)
- **Authorized official phone:** (817) 734-4854

## Contact information

- **Practice address:** 855 TEXAS ST STE 105, FORT WORTH, TX 76102-4574
- **Practice address phone:** (682) 990-6242
- **Mailing address:** 855 TEXAS ST, FORT WORTH, TX 76102-4572

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 03/26/2020
- **Last updated:** 03/26/2020