Organization
FORT WORTH PSYCHWORKS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN GADDIS PHD (OWNER)
(817) 349-7646
Entity
Organization
Contact information
Practice address
300 COLLEGE AVE, FORT WORTH, TX 76104-1121
(873) 349-7646
Mailing address
1704 6TH AVE, FT WORTH, TX 76110-6401
(502) 775-9063
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/18/2023
Last updated
04/23/2023
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