Individual
DR. MARY MADISON EAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4837 BRYCE AVE, FORT WORTH, TX 76107-4144
(817) 980-7474
Mailing address
4837 BRYCE AVE, FORT WORTH, TX 76107-4144
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
16-18P
AR
Other
Enumeration date
08/25/2016
Last updated
08/25/2016
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