Individual
LARISA JANAE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8745 ELBE TRL, FORT WORTH, TX 76118-7411
(405) 779-1310
Mailing address
8745 ELBE TRL, FORT WORTH, TX 76118-7411
(405) 779-1310
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
114139
TX
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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