Individual
MISS MARY JEAN WEBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3516 CANYON RIDGE AVE, FORT WORTH, TX 76103-3010
(682) 232-6560
Mailing address
3516 CANYON RIDGE AVE, FORT WORTH, TX 76103-3010
(682) 232-6560
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
320600000X
TX
Other
Enumeration date
10/11/2012
Last updated
10/11/2012
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