Individual
LESHEKA MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4412 COLUMBUS TRL, FORT WORTH, TX 76133-7465
(469) 685-3473
Mailing address
4412 COLUMBUS TRL, FORT WORTH, TX 76133-7465
(469) 685-3473
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Enumeration date
09/06/2013
Last updated
09/06/2013
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