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Individual

ANN REVARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
1314 LAKE ST STE 102, FORT WORTH, TX 76102-4582
(817) 810-0030
(817) 367-9615
Mailing address
1314 LAKE ST STE 102, FORT WORTH, TX 76102-4582
(817) 810-0030
(817) 367-9615

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
23021
CA
1041C0700X
Clinical Social Worker
Primary
50949
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
193616302
TX
Enumeration date
03/19/2008
Last updated
08/07/2025
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