Organization
TLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA RENE COOLEY-THOMAS MD ED (CEO/DIRECTOR)
(682) 622-1095
Entity
Organization
Contact information
Practice address
8425 HORNBEAM DR, FORT WORTH, TX 76123-5047
(817) 919-2378
Mailing address
8425 HORNBEAM DR, FORT WORTH, TX 76123-5047
(817) 919-2378
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/28/2017
Last updated
02/28/2017
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