Individual
AXEL T BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12650 N BEACH ST STE 146, FORT WORTH, TX 76244-4253
(855) 782-7822
Mailing address
9136 BELVEDERE DR, FORT WORTH, TX 76244-6214
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-125770
TX
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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