Individual
LORI FANGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4316 LATIGO CIR, FORT WORTH, TX 76244-8153
(469) 525-5775
Mailing address
4316 LATIGO CIR, FORT WORTH, TX 76244-8153
(469) 525-5775
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
73565
TX
Other
Enumeration date
06/03/2015
Last updated
06/03/2015
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