Individual
STACI GOTTLIEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, PMHNP
Contact information
Practice address
901 7TH AVE, SUITE 230, FORT WORTH, TX 76104-2722
(682) 885-1050
(682) 885-7572
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
741675
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293955504
—
TX
05
—
293955505
—
TX
01
—
8600NA
BCBS
TX
Enumeration date
11/07/2011
Last updated
07/29/2016
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