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Organization
FORT PHYSICIANS & PROFESSIONALS PLLC
Active
Organization
FORT PHYSICIANS & PROFESSIONALS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ALICE ANN KUCHINSKAS (PAYER RELATIONS)
(562) 544-7823
Entity
Organization
Contact information
Practice address
7140 OAKMONT BOULEVARD, FORT WORTH, TX 76132
(817) 678-7428
(682) 707-5750
Mailing address
32302 ALIPAZ ST SPC 41, SAN JUAN CAPISTRANO, CA 92675-4158
(562) 544-7823
(949) 485-6212
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/08/2020
Last updated
04/08/2020
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