Individual
MR. PHILLIP DAVID FITZPATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
6600 SANGER AVE, SUITE # 9, WACO, TX 76710-7814
(254) 722-6247
Mailing address
615 HARVEST LN, MC GREGOR, TX 76657-9713
(254) 722-6247
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
16268
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103097504
—
TX
Enumeration date
02/12/2007
Last updated
12/09/2010
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